'Minor' problems in pregnancy

Non-pathological nausea and vomiting are common in pregnancy, and are associated with a reduced rate of miscarriage, preterm birth, and intrauterine growth restriction. Treatment is by diet modification; and rarely by admission to hospital and steroid treatment. Tiredness is a common symptom, probably secondary to hormone changes. Most pregnant women in Western countries have adequate iron stores, and treatment for 'anaemia' is rarely necessary. The Hb concentration falls substantially in pregnancy, due to expansion of the plasma volume, and a fall of 1-3 g/dL is associated with an improved pregnancy outcome. Concentrations of 13 g/dL or higher in mid-pregnancy are associated with an increased incidence of pre-eclampsia, growth restriction and perinatal mortality, and concentrations of 8 g/dL or less are also associated with increased perinatal mortality. Restless legs and cramps at night are common and not usually pathological; the prescription of hypnotics should be avoided. There is an increased incidence of gum disease in pregnancy, and all women should be encouraged to see their dentist for appropriate treatment. Dysuria and frequency are very common in pregnancy, and as a result urinary tract infection is over diagnosed. Treatment should only be given following demonstration of significant bacterial infection on culture, or in the presence of symptoms such as pyrexia, rigors, and loin pain with suprapubic tenderness. Abdominal pain is also common and in 80% of cases has no demonstrable cause; however preterm labour should always be considered. Heartburn can be managed effectively by regular, rather than symptomatic, treatment with oral antacid.