Pregnancy: The First Trimester
The first trimester runs from the first day of your last period to the end of week thirteen, and almost all of the pregnancy's important development happens in it. Four things matter most in these weeks. Start folic acid at 400 micrograms a day — 5 milligrams if you have diabetes, epilepsy, a previous baby with a spinal defect, or a high body weight — and continue to at least twelve weeks, because it prevents defects of the brain and spine that form before most women know they are pregnant. Book your first antenatal visit before twelve weeks for a dating scan, blood group and Rh, haemoglobin, blood sugar, hepatitis B and C, HIV and syphilis testing, urine testing and a blood pressure reading. Expect nausea, exhaustion, sore breasts and frequent urination; these are normal, and the nausea usually eases by week fourteen. And learn the three signs that mean going to hospital rather than waiting: bleeding with one-sided lower abdominal or shoulder-tip pain, which can mean a pregnancy in the tube; vomiting so persistent you cannot keep fluids down; and heavy bleeding with faintness. Miscarriage happens in about one in five recognised pregnancies, nearly always for reasons that were set at conception and nothing you did or failed to do.
Health writers · Aslam Clinic
What the first trimester covers
Pregnancy is dated from the first day of your last menstrual period rather than from conception, which is a convention rather than a biological fact — it is simply the only date most people can name reliably. It means the count starts about two weeks before you actually conceived, and that a positive home test at a missed period usually puts you at around four to five weeks.
The trimester ends at the close of week thirteen. In that short window the neural tube closes, the heart starts beating, and every organ is laid down. It is the most vulnerable stretch of the whole pregnancy and, awkwardly, the stretch during which many women do not yet know they are pregnant. That single fact is why folic acid is advised before conception and why any woman who could become pregnant is asked about medicines she is taking.
Confirming the pregnancy and setting the date
A home urine test is accurate from about the day of a missed period, most reliably on the first urine of the morning. A negative test with a period still absent a week later should be repeated. Blood testing for the pregnancy hormone is used in clinics where the timing is unclear or an ectopic pregnancy is being ruled out, because the way the level rises over 48 hours carries information a single result does not.
An between roughly seven and thirteen weeks confirms that the pregnancy is inside the womb, that there is a heartbeat, how many babies there are, and — most usefully — the due date. Dating by scan in the first trimester is considerably more accurate than dating by your remembered period, and it is the date every later decision is measured against, so it is worth having even if everything feels fine. Where it is offered, a scan between eleven and just under fourteen weeks can also measure the fluid at the back of the baby's neck as part of screening for chromosomal conditions.
What most people feel
The early symptoms are driven by a steep rise in pregnancy hormones and by the extra blood volume the body starts making almost immediately. They vary enormously. Having very few symptoms is not a bad sign, and having severe ones is not a good one.
| Symptom | Usually | Speak to a doctor if |
|---|---|---|
| Nausea and vomiting | Starts week 5-6, worst around week 9, mostly gone by week 14-16. Not confined to mornings | You cannot keep fluids down for a day, you are losing weight, or your urine is dark and scanty |
| Exhaustion | Overwhelming in the first trimester and lifts in the second | You are also breathless on light activity or your heart races — this is often |
| Passing urine often | From very early on, day and night | There is burning, urgency, blood, or loin pain: that is a and needs treating in pregnancy even if mild |
| Cramping | Mild, low, period-like as the womb stretches | The pain is one-sided, severe, or comes with bleeding or faintness |
| Spotting | Light brown or pink, brief, in about one in four pregnancies | It is red, heavy, contains clots or tissue, or comes with pain |
| Constipation and | Extremely common as the gut slows | You want to take anything for it — check first, including antacids and herbal remedies |
| Headache and dizziness | Mild, from hormonal change and lower blood pressure | The headache is severe, with visual disturbance, or your is raised |
Folic acid, iron and calcium
Folic acid is the one supplement with a proven, large effect, and it has to be in your body before the neural tube closes at around four weeks. The dose is 400 micrograms daily, ideally from three months before conception and certainly until the end of week twelve.
A higher dose of 5 milligrams daily is recommended for women at increased risk: a previous pregnancy affected by a defect of the brain or spine, diabetes, a body weight in the obese range, sickle cell disease or thalassaemia, coeliac disease, and women taking medicines for epilepsy. If any of those apply, say so at the first visit rather than assuming the standard tablet is enough.
Iron is the second supplement, and it matters more here than in the countries most pregnancy leaflets are written in. The WHO recommends daily oral iron with folic acid through pregnancy, and in a population where is already widespread that recommendation is not a formality. Your doctor will check the and set the dose. Take iron with something acidic and away from tea, which blocks its absorption.
Calcium supplementation of 1.5 to 2 grams a day from the second trimester is recommended by the WHO in populations with low dietary calcium intake, because it reduces the risk of pre-eclampsia — the dangerous rise in blood pressure of later pregnancy. Pakistan is such a population. Ask about it at your first visit so it is started at the right time.
Antenatal visits and the first tests
The WHO recommends a minimum of eight antenatal contacts across a pregnancy, with the first before twelve weeks. That first visit does more than confirm the pregnancy — it is where problems that are silent now and dangerous later get found.
- Blood group and Rhesus type. If you are Rh negative and your partner is not, anti-D injections at the right times protect this pregnancy and the ones after it. Knowing your group early is also what makes a transfusion safe if one is ever needed.
- for and count. Thalassaemia screening is offered where there is a family history or a suggestive blood count, which in Pakistan is a common and worthwhile question.
- Blood sugar, and a tolerance test later for anyone at higher risk of pregnancy diabetes — which includes a family history of , a previous large baby, and a raised .
- Hepatitis B and hepatitis C, and HIV and syphilis. All four change management, and hepatitis B in particular can be prevented in the baby by vaccinating at birth.
- for protein, sugar and infection. Bacteria in the urine without any symptoms is treated in pregnancy, which is not the case outside it.
- and weight at every visit from the start, so a later rise has something to be compared with.
- testing where there are symptoms, a family history, or previous thyroid disease. Untreated in pregnancy matters, and it is easy to treat.
Vaccination in pregnancy
Tetanus-containing vaccine is the core of Pakistan's antenatal schedule, given as a course during pregnancy or as a booster if you have had doses before. It protects the newborn against tetanus of the umbilical cord, which is still a real cause of newborn death here and is almost entirely preventable. Check your card at the first visit rather than at the end.
Inactivated — including influenza and tetanus — are safe in pregnancy. Live vaccines such as measles-rubella and varicella are not given during pregnancy and are deferred until after delivery. If you are due any vaccination and think you might be pregnant, say so first.
Food, water and daily life
- Eat regularly and small. An empty stomach makes nausea worse. Dry toast or a rusk before getting out of bed, then something every two to three hours, works better than three large meals.
- Boil loose milk before drinking it or making dahi and lassi from it. Cook meat and eggs right through. Wash fruit and salad in clean water and peel where you can. Avoid cut fruit, ice and juices from a cart.
- Caffeine under about 200 milligrams a day — roughly two cups of instant coffee or three to four cups of tea. Doodh patti and energy drinks count.
- No tobacco in any form, including naswar, paan, gutka and shisha, and stay out of rooms where people are smoking. No alcohol: no safe amount has been established.
- Keep moving. Walking, household activity and swimming are all good in an uncomplicated pregnancy. Avoid contact sports, heavy lifting to the point of straining, and getting overheated.
- Drink for the climate. Dehydration comes fast in a Punjab summer and makes nausea, constipation and dizziness worse. Aim for pale urine.
- Sex is safe in an uncomplicated pregnancy and does not cause miscarriage.
Medicines in pregnancy
Paracetamol is the usual first choice for pain or fever in pregnancy, at the lowest dose that works and for the shortest time. such as ibuprofen, diclofenac and mefenamic acid are generally avoided unless a doctor has specifically advised one, particularly after twenty weeks.
Never stop a prescribed long-term medicine on your own because you have found out you are pregnant. Uncontrolled epilepsy, , , and serious mental illness are each more dangerous to a pregnancy than the medicines used to treat them. Some drugs genuinely do need changing — isotretinoin for acne, and the ACE inhibitor and ARB classes used for and kidney protection, are the common examples — and that change is made by the prescriber, quickly, not by stopping and hoping.
A pharmacy counter is not the place to settle a medicine question in pregnancy. That includes antibiotics, anti-sickness tablets, painkiller injections, weight-loss products and herbal preparations.
Miscarriage, plainly
About one recognised pregnancy in five ends in miscarriage, the great majority before twelve weeks. In most cases the cause is a chromosomal error present from conception — the pregnancy could not have continued whatever anyone did. It is not caused by lifting a bucket, by working, by a rickshaw ride, by an argument, by sex, or by having been on contraception before.
The usual signs are bleeding and cramping, though a miscarriage is sometimes found on a scan with no symptoms at all. Any bleeding in early pregnancy should be assessed the same day, because the same symptom can mean an ectopic pregnancy, which is dangerous, or a pregnancy that is continuing normally, which is common. If a miscarriage is confirmed, there is more than one way to manage it — waiting, medicine, or a short procedure — and the choice is genuinely yours to make with your doctor. One early miscarriage does not reduce the chance that the next pregnancy will be healthy, and investigation is usually offered after three.
When to see a doctor
Book the first antenatal visit as soon as the test is positive, aiming to be seen before twelve weeks. Go sooner if you have a long-term condition, take regular medicines, have had a previous miscarriage, ectopic pregnancy or caesarean, or are over 35 or under 18.
Between visits, contact a doctor the same day for any bleeding, any fever, burning on passing urine, persistent vomiting, severe headache, swelling of the face and hands, or abdominal pain that is more than mild cramping. Go straight to a hospital for one-sided or shoulder-tip pain, heavy bleeding, or faintness. Nothing on that list is something to apologise for checking.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
