Pregnancy symptoms you should never ignore

Your body changes so rapidly during pregnancy that it's hard to know whether a new ache or  pain or other symptom is normal, or whether you should call your healthcare provider or even head to the emergency room.

It's smart to be cautious and to pay attention to new symptoms during pregnancy. Tragically, about 700 women die in the U.S. each year from complications related to pregnancy – and most of these deaths could be prevented.

Be aware of potentially dangerous symptoms and check in with your doctor or midwife anytime something doesn't feel right. If you're unsure but worried, trust your instincts and contact your provider.

Early pregnancy symptoms not to ignore

Early pregnancy often brings a host of unpleasant side effects, most of which are par for the course. Nausea and vomiting, tiredness, and even some minor cramping and spotting are normal. Still, some symptoms may signal a problem such as a miscarriage or an ectopic or molar pregnancy.

Call your doctor or midwife if you have:

Bleeding or spotting

Many women have some bleeding or spotting in early pregnancy, with no problems. (Implantation bleeding can happen when the fertilized egg implants in the uterus, about six to 12 days after conception.)  But vaginal spotting or bleeding – which may look like the start of a light period – can also be the first sign of miscarriage. Or it can signal an ectopic or molar pregnancy.

You may have intermittent bleeding or continuous bleeding, and it may be heavy or light.

If you have a molar pregnancy, you may pass small, fluid-filled sacs from your vagina.

Pain

A little crampy abdominal pain early in pregnancy is often nothing to be concerned about. (Implantation can cause light cramps in early pregnancy.) But if you have cramping along with other symptoms, such as bleeding, or the cramping is severe, it may signal a complication. For example:

• You may have crampy, persistent abdominal pain or sharp pain. Or it may feel more like pelvic pressure or low back pain. It may come on after you have bleeding, which could indicate that you're miscarrying.
• Pain anywhere in your abdomen or pelvis – whether it's mild and intermittent or sudden and severe – can signal an ectopic pregnancy. The pain may get worse when you're active, have a bowel movement, or cough.
• Pain in your shoulder, especially when you're lying down, can be a symptom of a ruptured ectopic pregnancy, which is a medical emergency. Call 911 right away.
• A molar pregnancy can cause abdominal cramping and pelvic pressure or pain, as well as severe nausea and vomiting.

Late pregnancy symptoms not to ignore

Many discomforts and changes in later pregnancy are perfectly normal, but you'll want to be aware of signs of problems such as preterm labor and preeclampsia, which can be especially dangerous. Call your doctor or midwife if you experience:

Less baby movement

You'll probably start to feel your baby move when you're about 16 to 22 weeks pregnant, though the movements will be faint at first. By the end of your second trimester or early in the third trimester, your baby's kicks will become stronger and more frequent. If at any time you think the frequency of your baby's movements has slowed down, or something seems off, contact your provider.

Also, ask your provider whether you should monitor your baby's activity by doing daily kick counts in your third trimester. They can give you specific instructions on how to count and when to call.

Slowing of your baby's movements may be a sign of a uterine infection, low amniotic fluid, and/or fetal distress.

A gush or trickle of water

If your water breaks or you're leaking amniotic fluid and you're not yet in labor, it means you have pre-labor rupture of membranes (PROM). If your water breaks before 37 weeks, it's called preterm pre-labor rupture of membranes (PPROM), and it means you may deliver your baby prematurely.

Call your provider whenever your water breaks. Depending on how far along you are, they may try to delay delivery or they may induce labor or recommend a cesarean section.

Intense itching

It's normal for your skin to be a little itchy when you're pregnant, especially if you have stretch marks. If you have an itchy rash later in pregnancy that starts out as small, pimply dots (and may later develop into patches of raised lesions), you may have PUPPP, pruritic urticarial papules and plaques of pregnancy. It's not dangerous, though the itching can be intense.

But if you have sudden, severe itching without a rash – usually starting on the palms of the hands and soles of the feet and maybe spreading to the trunk of the body – talk with your provider. This kind of itching may be a sign of a rare but potentially dangerous liver disorder called cholestasis of pregnancy, which usually starts in the third trimester and can increase the risk of stillbirth and preterm birth.

Serious headache

A mild headache is normal, especially early in pregnancy, thanks to hormone fluctuations. But in the second or third trimester (or in the first few weeks postpartum), a persistent or severe headache that doesn't go away when you rest or take acetaminophen may be a sign of preeclampsia. It may also be a symptom of a migraine or, rarely, a stroke.

You may have a severe, throbbing headache that starts suddenly on one side of your head, above your ear. A headache is especially worrisome if you don't usually have headaches and/or it's accompanied by blurred vision or slurred speech.

Rapid weight gain

Gaining more than three to five pounds in one week – especially in the second half of pregnancy – can be a sign of preeclampsia. You may also have sudden swelling (see below). Not all women with preeclampsia have rapid weight gain, though.

Vision changes

Vision changes, especially at or after 20 weeks of pregnancy, can be a sign of preeclampsia. Be alert for:

• Persistently blurry vision
• Seeing spots or flashing lights
• Light sensitivity

Vision changes along with other symptoms – such as headaches, swelling, or rapid weight gain – are especially worrisome.

Symptoms that can be warning signs throughout pregnancy

Some symptoms can signal a problem no matter when they occur in pregnancy. Also, be sure to keep an eye on any other health problem that you'd normally call your provider about, even if it isn't related to your pregnancy. If you have worsening asthma, or a cold that's getting worse instead of better, for example, give your doctor or midwife a call.

Here are symptoms to look out for:

Painful or burning urination

Feeling the urge to go again minutes after peeing, having painful or burning urination, having little or no urination, and having urine that's cloudy, blood-tinged, or has a strong odor can be signs of a urinary tract infection. If you have a UTI, you may also have soreness in your back, sides, or lower abdomen. If it spreads to the kidneys, you may have back pain, fever and chills, and nausea and vomiting.

If you have a UTI during pregnancy, your provider will prescribe oral antibiotics and test you periodically to see that the infection has cleared. If you develop a kidney infection, you'll need IV fluid and antibiotics, and you'll need to be monitored in the hospital.

Strange vaginal discharge

Vaginal discharge that's clear or milky white is called leucorrhea and is perfectly normal. You may have more of it than usual during pregnancy thanks to higher levels of estrogen in your body.

But if at any time in pregnancy you have discharge that's green or unpleasant smelling, or if it's accompanied by pain or itching, you may have an infection. If your vulva is inflamed or you have pain, soreness, itching, or burning, you may have a yeast infection. If the discharge is thin and white or gray with a strong fishy smell, you may have bacterial vaginosis (BV). If it's yellow or green and smells unpleasant, you may have trichomoniasis (a common STI).

Read our article on vaginal discharge during pregnancy for help decoding vaginal discharge.

Note that an increase in mucus-like discharge after 37 weeks is normal and may indicate that your body's preparing for labor. Read about losing your mucus plug.

Bleeding

Early in pregnancy, some bleeding or spotting can be normal – or it can be a sign of a miscarriage or an ectopic or molar pregnancy.

Throughout pregnancy, it's normal to have a little spotting after sex or a vaginal exam. But if you continue to bleed, or if you bleed at other times, it may be a sign of placenta previa or placental abruption. It's especially worrisome if you're having other symptoms, such as fever or pain.

Pain

Some discomfort is to be expected in pregnancy. You might have round ligament pain, for example, or leg cramps. But sometimes pain is a red flag.

Where your pain is located and whether it's sudden or severe can be a clue to complications. For example:

• Back pain. Suddenly worse or new lower back pain late in pregnancy can be a sign of preterm labor, especially if you didn't have back pain before. If you have back pain along with a fever, you may have a kidney or bladder infection. Back pain can also signal placental abruption, a miscarriage, or a cyst.
• Pelvic pain or menstrual-like cramping or stomach pain may also be a sign of premature labor. Abdominal pain along with other symptoms, such as vomiting or diarrhea, might indicate a UTI or a gastrointestinal virus. Cramping, uterine tenderness, or abdominal pain can also be a sign of placental abruption.
• Pain in the upper abdomen or shoulder can be a symptoms of preeclampsia or HELLP syndrome. Pain under the ribs on the right side can also be a sign of HELLP syndrome.
• Chest pain or pressure in the center of your chest that travels to your arm, neck, or back, may be a sign of a heart attack, blood clot, or other problems with blood flow. A fast or irregular heartbeat or pounding in your chest, sweating, or trouble catching your breath are other signs. It's especially worrisome if these signs start suddenly and/or you also have swelling in your arm or leg, dizziness, or a headache.

Fever

Chills or fever of 100.4 degrees Fahrenheit or higher may be caused by an infection – in the kidneys, uterus, lungs, or elsewhere. This is especially true if you have other symptoms, such as belly or back pain, nausea, diarrhea or vomiting, trouble urinating, or foul-smelling vaginal discharge.

Flu-like symptoms

Don't dismiss flu symptoms during pregnancy. You're more likely to develop a severe case of the flu when you're pregnant and suffer serious complications, including pneumonia and preterm birth.

In addition, flu symptoms – such as fever, achiness, fatigue, headache, a runny or stuffy nose, a sore throat, coughing, and chills – may also be signs of COVID-19. You're also at higher risk of severe illness, hospitalization, and pregnancy complications if you're infected by COVID-19 during pregnancy.

Severe nausea and vomiting

Severe nausea and vomiting, called hyperemesis gravidarum (HG), can cause problems such as weight loss, low birth weight, and dehydration. HG can start in early pregnancy and continue throughout.

If you have persistent nausea and vomiting several times a day, can't keep any fluids down for 12 hours, or are lightheaded from vomiting, tell your doctor or midwife. You may need to be treated with IV fluids and anti-nausea medication.

If you haven't been nauseated during pregnancy and suddenly are, you may have a viral infection, a problem with your liver or pancreas, or food poisoning. Sudden nausea in the second half of pregnancy may be a sign of preeclampsia.

Swelling

Some swelling during pregnancy, especially in the later months, is perfectly normal. But some types of swelling can indicate preeclampsia:

• persistent, severe swelling in your face
• persistent, severe puffiness around your eyes
• severe and sudden swelling of your feet or ankles, particularly in the morning

Swelling, pain, or tenderness in one leg or one arm is also concerning, because it may be a sign of deep vein thrombosis (a clot in your vein). The limb may also be red or swollen and warm. This can happen anytime in pregnancy or up to six weeks postpartum. Deep vein thrombosis can travel and lead to a pulmonary embolism or a stroke.

Dizziness or fainting

If you have dizziness or lightheadedness that's ongoing or comes and goes over many days, if you faint or pass out, or if you experience a loss of memory, it may be a sign of preeclampsia, a stroke, a heart or lung problem, bleeding, or problems with blood sugar level. Dizziness or fainting can signal a problem at any time in pregnancy.

Feeling depressed or anxious

If you feel profoundly sad or hopeless, have panic attacks, feel unable to handle your daily responsibilities, or have thoughts of harming yourself, seek help immediately. About 1 in 10 women experience depression during pregnancy and up to 1 in 5 women have anxiety during pregnancy or after.

Also, if you have a new, sudden sense of heightened anxiety and/or mental confusion, it may be a sign of preeclampsia.

Trouble taking a deep breath

Occasional shortness of breath during pregnancy is normal, but you may also be having symptoms of a respiratory infection or worsening asthma (if you experience asthma).

Shortness of breath during pregnancy is worrisome if it's sudden or severe, or if it's accompanied by a rapid pulse or heartbeat, chest or back pain, paleness, headache, swelling, changes in vision, or a feeling that you're going to faint.

These may be signs of preeclampsia, a lung infection, a pulmonary embolism, or a heart problem that's getting worse. Call your provider right away. If it's an emergency (is severe) or you can't get in touch with your provider, call 911 or go to the emergency room.

Extreme tiredness

Pregnancy may leave you feeling chronically fatigued at times, but if you're suddenly very tired and weak and don't feel refreshed no matter how much you sleep, it can be a sign of heart disease, anemia, diabetes, or depression.

When should I call my doctor or midwife during pregnancy?

If you have any of the symptoms above, call your provider. Also call if you feel that something just isn't right, even if you're unsure. It's better to be reassured than to ignore a potential complication.

It's also a good idea to talk with your doctor or midwife at a prenatal visit about what symptoms they'd like to be alerted to. Depending on your individual situation, they may instruct you to be on the lookout for particular symptoms. (If your blood pressure is trending high, for example, they may want you to be especially sensitive to signs of preeclampsia.)

Learn more:

• Twelve steps to a healthy pregnancy
• Prenatal testing
• How to stay hydrated during pregnancy