Pregnancy Symptoms by Trimester: A Complete Guide

Morning Sickness (Nausea and Vomiting)

About 70 to 80% of pregnant women experience nausea. It usually starts around week 6, peaks between weeks 8 and 10, and resolves by week 14 for most women. Some have nausea through the entire pregnancy.

In Singapore's heat and humidity, nausea can feel worse. The smell of hawker centres, spicy food, and strong cooking smells are common triggers. Cold foods produce fewer smells than hot food - many women find cold fruit, plain bread, or refrigerated crackers easier to tolerate. Air-conditioned spaces help too.

• Eat small meals every 2 to 3 hours - an empty stomach makes nausea worse
• Keep plain crackers by your bed and eat before getting up
• Ginger tea or ginger biscuits have strong evidence behind them
• Vitamin B6 (10 to 25mg) can reduce nausea - ask your doctor
• Avoid strong-smelling food stalls or open kitchens when possible

If you cannot keep any fluids down for more than 24 hours, go to KKH A&E or your nearest hospital. This is hyperemesis gravidarum and requires IV fluids.

Breast Tenderness and Changes

Breast changes begin almost immediately after implantation. Your breasts may feel sore, heavy, or tingly - similar to pre-period soreness but more intense. This is caused by rising oestrogen and progesterone preparing your breasts for milk production.

• Bra size may increase by 1 to 2 cups by the end of the first trimester
• Nipples and areolae often darken and become more sensitive
• Small bumps (Montgomery's tubercles) appear around the nipple - these are normal oil glands
• A well-fitted supportive bra, including a sleep bra if needed, helps manage discomfort

Fatigue

First trimester fatigue is real and often underestimated. Progesterone has a sedating effect, your body is producing more blood, and your heart is pumping harder - all at the same time. It is normal to feel wiped out by mid-afternoon or need to go to bed at 8pm.

• Most women need 9 to 10 hours of sleep during the first trimester
• Napping is fine and recommended if you can manage it
• Fatigue usually lifts significantly in the second trimester
• Iron deficiency can worsen fatigue - check your iron levels at your next antenatal visit

Frequent Urination

From around weeks 6 to 8, you may notice you need to use the bathroom much more often. Your kidneys process about 50% more blood during pregnancy, which means more urine production. The growing uterus also puts pressure on your bladder.

This is normal. Do not reduce your water intake to manage it - staying hydrated is important for you and your baby. Frequent urination is uncomfortable but harmless unless accompanied by pain or burning (which may indicate a urinary tract infection).

Food Aversions and Cravings

Strong smell and taste changes are very common in early pregnancy. Foods you used to love may become repulsive. Foods you never wanted may suddenly seem appealing. This is thought to be related to hCG levels and changes in smell perception.

• Avoiding certain hawker centres or specific dishes is common and fine
• Strong food smells - especially meat, fish, or spicy food - are common triggers for nausea
• Eat what you can keep down during early pregnancy - nutritional perfection can wait until week 14
• Cravings for non-food items (ice, dirt, chalk) are called pica - tell your doctor if this happens

Bloating and Constipation

Progesterone slows down your entire digestive system. This causes bloating, gas, and constipation from very early in pregnancy. The slowing is intentional - it gives your body more time to absorb nutrients from food. But it is uncomfortable.

• Drink at least 8 glasses of water daily
• Increase fibre intake - vegetables, fruit, wholegrain bread
• Ripe papaya and prunes are gentle natural options that help
• Light walking after meals helps move digestion along
• Avoid iron supplements on an empty stomach - they worsen constipation
• If constipation is severe, ask your doctor about pregnancy-safe laxatives like lactulose

Note: unripe papaya should be avoided in pregnancy. Only ripe papaya in moderate amounts is considered safe.

Round Ligament Pain

Round ligament pain is a sharp, stabbing pain on one or both sides of the lower abdomen. It happens when you stand up quickly, sneeze, cough, or roll over in bed. It lasts only a few seconds and is caused by the ligaments that hold up your uterus stretching as it grows.

It is alarming if you are not expecting it, but it is normal. Moving more slowly - especially when changing positions - reduces how often it happens. If you have constant pain that does not go away, or pain with fever or bleeding, see your doctor.

Braxton Hicks Contractions

From around week 20, you may feel your uterus tighten and harden briefly then relax. These are Braxton Hicks contractions - sometimes called "practice contractions." They are irregular, usually painless or mildly uncomfortable, and go away when you move around, rest, or drink water.

They are not a sign of labour. The key difference between Braxton Hicks and true labour contractions is regularity and intensity - true contractions get stronger, longer, and closer together. Use our contraction timer if you are unsure.

Back Pain

As your uterus grows, your centre of gravity shifts forward. This puts more strain on your lower back. The hormone relaxin also loosens your ligaments and joints - which helps your pelvis open for birth but also reduces spinal support.

• Swimming is one of the best exercises for back pain in pregnancy - the water takes weight off your spine
• Prenatal yoga strengthens the core muscles that support your back
• Sitting on a birthing ball at your desk reduces lumbar strain
• Avoid standing for long periods - shift weight from foot to foot if you must
• KKH and NUH both offer physiotherapy referrals through the antenatal care team

Skin Changes

The second trimester is when most pregnancy-related skin changes appear.

• Linea nigra - a dark vertical line running down the centre of the belly. This is caused by hormones stimulating melanin production. It fades after birth.
• Melasma (pregnancy mask) - brown patches on the face, especially the cheeks, forehead, and upper lip. Singapore's UV index is consistently high. SPF 50 sunscreen every day and a wide-brimmed hat when outdoors will reduce how dark it gets.
• Stretch marks - pink or red streaks on the belly, breasts, hips, and thighs as the skin stretches. They start appearing now. Moisturising reduces itchiness but has weak evidence for preventing them - genetics is the main factor.

Increased Appetite

As nausea fades, your appetite often returns strongly. The old advice to "eat for two" is a myth. You only need about 300 extra calories per day in the second trimester - roughly a bowl of brown rice or a banana and a glass of milk.

Focus on quality rather than quantity. More protein, more iron, more calcium. HPB's HealthHub has a pregnancy nutrition guide with local food swaps and recommended serving sizes based on Singaporean diets.

Baby Movements (Quickening)

Feeling your baby move for the first time is called quickening. For first-time mothers, this usually happens between 18 and 22 weeks. If you have been pregnant before, you may feel it earlier - from around 16 weeks - because you know what to look for.

Early movements feel like gentle flutters, bubbles, or a light tapping sensation. Over the coming weeks, they become clearer kicks and rolls. By week 28, you should be able to feel a regular pattern of movement each day.

Shortness of Breath

As the uterus grows upward, it pushes against the diaphragm and limits how fully your lungs can expand. Feeling slightly breathless when walking up stairs or doing normal activity is common from around week 28.

Sitting up straight and sleeping slightly propped up can help. See your doctor if breathlessness comes on suddenly, is severe at rest, or comes with chest pain - these need prompt assessment.

Heartburn and Acid Reflux

The growing uterus pushes stomach acid upward, and the valve between the stomach and oesophagus relaxes due to progesterone. The result is a burning sensation in the chest or throat, especially after eating.

• Eat smaller, more frequent meals rather than large ones
• Avoid lying down within 2 hours of eating
• Avoid spicy, oily, or fried hawker food in the evenings
• Sitting upright after meals and sleeping with your head raised helps
• Antacids like Gaviscon are considered safe in pregnancy - check with your pharmacist

Swelling (Oedema)

Swelling in the feet and ankles is very common from week 28 onward. Your body holds more fluid during pregnancy, and the weight of the uterus can slow blood return from your legs. Singapore's heat makes this worse.

• Elevate your feet when sitting - put them up on a stool or cushion
• Reduce your salt intake
• Compression socks help - wear them before getting out of bed in the morning
• Keep cool and stay in air-conditioned spaces during the hottest part of the day
• Gentle walking helps circulate blood and reduce pooling

See a doctor immediately if your face or hands swell suddenly, especially with a headache or visual changes. This can be a sign of pre-eclampsia.

Pelvic Girdle Pain (PGP)

Pelvic girdle pain causes discomfort in the pubic area, hips, or inner thighs. It is caused by the hormone relaxin loosening the joints around the pelvis too much. You may hear a clicking sound. It is worse on stairs, standing on one leg, or rolling over in bed.

• Ask for a physiotherapy referral at your next appointment at KKH or NUH
• A pelvic support belt worn low across the hips reduces discomfort
• Keep your knees together when getting in and out of the car
• Sit down to get dressed rather than standing on one leg
• Avoid activities that make it worse - swimming is usually well tolerated

Insomnia and Discomfort

Finding a comfortable sleeping position becomes genuinely hard in the third trimester. The recommended position is on your left side - this improves blood flow to the placenta and reduces pressure on major blood vessels. Lying flat on your back for long periods is not recommended after week 28.

• A pregnancy pillow (U-shaped or C-shaped) between your knees and under your bump helps a lot
• Use a regular pillow behind your back to stop rolling onto your back in sleep
• Heartburn, leg cramps, and the need to urinate frequently all disrupt sleep - address each one
• Short naps during the day are helpful if night sleep is broken

Nesting Instinct

Many women feel a strong urge to clean, organise, and prepare the home before the baby arrives. This is called the nesting instinct and is most common from weeks 36 to 40. It is a normal and healthy response. Just avoid anything that requires heavy lifting, climbing ladders, or exposure to strong chemical cleaners.

Sharp, stabbing pain in lower abdomen or groin, usually brief (seconds). Caused by stretching of the ligaments supporting the uterus. Common in T2.

Lower back ache, usually dull. Due to posture shift, weight gain, and relaxin hormone loosening ligaments. Common throughout T2 and T3.

Pain in the pubic bone, groin, and inner thighs. May click. Worse on stairs, standing on one leg, rolling in bed. Caused by relaxin and symphysis pubis dysfunction.

Tightening or hardening of the uterus. Irregular, painless or mildly uncomfortable. Increases toward term.

Upper abdominal or rib pain in T3 is common - Baby's feet or uterine pressure. Also normal to feel baby's kicks under ribs.

Common in T1 due to hormonal changes and increased blood volume. Dehydration and blood pressure changes also contribute.

These symptoms need medical input but are unlikely to be an immediate emergency. Call your obstetrician's clinic or the antenatal day unit at KKH or NUH and describe what you are experiencing.

• Mild swelling of feet and ankles (without face or hand swelling)
• New or worsening back pain
• Baby moving less than usual but you can still feel some movement
• Mild spotting with no pain (especially in early pregnancy after sex)
• Concerns about constipation, heartburn, or other discomforts not responding to home measures
• New rash or skin changes you are not sure about