If you experience acne during your pregnancy, I recommend that you:

• Wash your face twice daily with a mild cleanser and lukewarm water; changing your face cloth daily

• Shampoo every day and try to keep your hair off your face

• Avoid picking or squeezing pimples and pustules

• Choose oil-free cosmetics

• Avoid very hot showers, steam rooms and baths.

For more severe cases, I am able to prescribe certain topical or oral antibiotics that are pregnancy-safe. Other common acne treatmets, such as oral isotretinion, may be contraindicated.

This is very common, and may be due to a combination of:

• Strain on your back muscles as your uterus becomes heavier

• Abdominal muscle stretching and weakness

• Pregnancy hormones, which relax the ligaments of the joints in the pelvis

In order to reduce the risk of this occurring, I suggest:

• Wearing shoes with good arch support

• Sleeping on your side (preferably on a firm mattress), with a pillow between your legs or under your abdomen for support

• Squatting down, bending your knees and keeping your back straight when picking things up

• Sitting in chairs with good back support, or using a small pillow behind the low part of your back

• Pre-natal pilates to strengthen your core, hips and gluteal muscles

If you experience back pain or pelvic girdle pain, I will discuss with you management options including:

• Physiotherapy and pre-natal pilates

• Massage (I recommend visiting only therapists who specialise in pregnancy massage)

• Heat packs

• Medications for pain relief

• Supportive pregnancy belts

Constipation occurs commonly in pregnancy because of hormonal changes that cause relaxation of the muscles of the gastrointestinal tract. If you are constipated, I suggest implementing the following strategies:

• Go to the toilet when you feel the urge, and avoid straining when sitting on the toilet

• Exercise regularly

• Increase your fluid intake to at least 7–8 glasses of water/juice/herbal tea per day 

• Fruit juices (especially pear juice or prune juice) provide particularly effective relief. I suggest 1–2 glasses per day

• Caffeine intake should be minimised 

• Eat plenty of high-fibre foods (whole grain cereals and bread, bran, fresh fruits and vegetables, nuts, dried fruits and legumes). Increase your fibre intake gradually to help prevent bloating

• Laxatives may be required. I recommend using Coloxyl as a stool softener and Movicol as an agent to treat constipation, usually in combination. Please do not use Senna-containing laxatives, liquorice or other laxatives without consulting me.

Excessive salivation, medically referred to as ptyalism or sialorrhea of pregnancy, typically begins in the first trimester. Symptoms usually resolve in the second trimester, but may persist throughout the entire pregnancy. It is often associated with nausea, vomiting and gastroesophageal reflux, and treating these may reduce excessive salivation. Other management strategies include frequent coughing or spitting to eject phelgm, chewing gum or sucking on lozenges, and having frequent drinks of water.

Mild, semi-frequent abdominal pain in the first trimester is very common and many patients describe this pain as feeling similar to period pain. This cramping or discomfort is caused by a few factors. Firstly, your uterus is beginning to grow and stretch, as new blood vessels are created to direct extra blood to this organ. Additionally, the corpus luteum (the follicle in your ovary from which the egg was released) is now functioning as the hormonal support for your pregnancy, until the placenta takes over in the late first/early second trimester — this is also becoming enlarged. Together, these changes in the uterus and ovary create pressure in the abdomen. Additionally, your progesterone levels are rising rapidly and this can cause the bowel to slow down, creating abdominal discomfort. All of these changes are normal and appropriate for the first trimester. 

It is important to remember that in some cases pain can be a cause for concern and further investigation may be required. If the pain becomes moderate/severe or it is worsening, or if it is accompanied by vaginal bleeding, fever, chills and/or shoulder tip pain, it is important to seek medical advice quickly.

Haemorrhoids tend to occur in late pregnancy and often resolve soon after birth. Management options include:

• Prevention and treatment of constipation 

• Topical ointments eg. Rectinol or Proctosedyl. Use should ideally be limited to less than seven days, as overuse can lead to skin irritation and thinning.

• Warm baths 

• Surgery — this is rarely required

During pregnancy, hair on your head and body may grow and become thicker. About three months after childbirth, as hormones return to normal levels, most people notice hair loss from the scalp. Hair should grow back completely and return to normal within 6 months of giving birth.

Heartburn usually gets worse over the course of the pregnancy, then goes away after birth. If you suffer from heartburn, I recommend the following:

• Eat multiple small meals a day and avoid foods that make symptoms worse, such as caffeinated drinks, chocolate and fatty foods

• Avoid lying down within three hours of eating

• Sleep in a position where your head is slightly more elevated, by using an extra pillow

• If required, try an antacid (such as Gaviscon or Mylanta). If your heartburn is still problematic despite this I may prescribe other medications that reduce acid production

Insomnia affects a large number of patients during pregnancy with increasing frequency as gestation advances: one in four people report suffering from insomnia in the first trimester, and two-thirds of patients are affected by the end of the third trimester. In early pregnancy, insomnia may be related to nausea and urinary frequency. As the pregnancy progresses, heartburn, fetal movements and leg cramps may be responsible for sleep disturbance. Management of insomnia involves addressing the underlying cause, but often also requires additional medications to enable adequate sleep. I recommend over-the-counter sedating antihistamines, such as Doxylamine (Restavit) or Promethazine (Phenergan).

It is normal to have nausea and vomiting in early pregnancy. It most often starts between the fourth and seventh weeks and usually settles by twelve to fourteen weeks. It is very uncommon for it to continue past this point, but if it does it almost always stops by sixteen to twenty weeks. Despite often being referred to as ‘morning sickness,’ it can occur at any time of the day or night. Reassuringly, it does not increase the risk of miscarriage; in fact, it is associated with a lower chance of miscarriage.

In about 3% of pregnancies it is severe to the point of causing dehydration and significant weight loss, when it is referred to as ‘hyperemesis gravidarum.’

Management strategies include:

• Rest — symptoms often improve with increasing rest, although this may be difficult if you are working or have young children

• Dietary modifications 

  • Eat multiple small meals per day — this may involve continuously nibbling away at fresh fruit, dried fruit or dried biscuits or alternatively having five to six meals a day with a short interval in between

  • Avoid foods that are fatty, greasy, spicy or acidic

  • Consider eliminating dairy and wheat products from your diet and replacing them with rice and soya based products

  • The ‘wet and dry’ diet is popular. This involves alternating wet and dry foods. For example, toast for breakfast, a milkshake for morning tea, a sandwich for lunch, soup for afternoon tea, a normal dinner and then another milkshake before bed

  • Try eating dry crackers or toast in the morning before you get out of bed to avoid moving around on an empty stomach

  • Drink cold, clear beverages such as sports drinks and ginger ale

  • Avoid coffee

• Ginger tablets

• Anti-nausea medications — there are a number of medications that I can prescribe to improve your symptoms

• Acupuncture or wrist acupressure

• Hospitalisation — at its most extreme, vomiting can be so severe that hospitalisation is required. Intravenous fluids for rehydration and strong medication may be necessary to prevent more serious complications. This is extremely unusual. If you are at the stage where you are vomiting more than twice a day, you should not hesitate to contact me, so you can avoid getting into this more serious situation.

Significant vomiting can cause some of your tooth enamel to wear away. I suggest rinsing with a teaspoon of baking soda dissolved in a cup of water after vomiting to help protect your teeth.

Leg cramps and restless legs syndrome are common in the third trimester but improve or remit after delivery. Strategies for prevention or relief of cramps include: 

• Massage 

• A warm bath prior to bedtime

• Drinking adequate fluids

• Prophylactic night-time calf stretching

• Vitamin and mineral supplementation — iron, calcium, magnesium or vitamin B supplementation may be effective, but results are inconsistent

• Medications — sedatives (eg. low dose clonazepam) may be used

These may occur on the breast/chest, inner thighs or face (brown patches around the cheeks, nose and forehead are known as melasma). They tend to fade on their own after birth, but may last for years. To prevent melasma from worsening, wear sunscreen and a wide-brimmed hat when outside. Avoid laser-facial treatments such as Fraxel while pregnant.

Stretch marks commonly occur on the abdomen, buttocks, breasts/chest or thighs. They usually fade after the baby is born, but may never completely disappear. There is no proven method of prevention or treatment.

Swelling of the feet and ankles is common as your pregnancy progresses, and resolves postpartum. In order to avoid swelling, I advise you to: 

• Exercise regularly

• Avoid standing for long periods of time — lying down with your feet elevated is effective 

• Sleep on your left side if possible

• Wear graduated compression stockings

• Wear loose clothing

Sudden swelling that is painful (especially if affecting one leg only) might be indicative of deep vein thrombosis. A sudden increase in swelling may be a symptom of high blood pressure. Please call me immediately if you experience either of these symptoms as both of these conditions require prompt assessment.

It is common to have increased vaginal discharge during pregnancy. Please notify me if the discharge becomes itchy or malodorous.

Varicose veins are common and tend to improve within three to four months of giving birth. In order to minimise them during your pregnancy I suggest: 

• Exercising regularly

• Elevating your feet and legs to the level of your heart or higher whenever possible

• Not crossing your legs or ankles when sitting

• Avoiding sitting or standing for long periods of time — try to move around frequently

• Wearing graduated compression socks or stockings, which are tight at the ankle and get looser as they go up your leg. Put them on before getting up in the morning and keep them on all day

• Sleeping on your left side if possible

If you experience vulvovaginal varicosities, in addition to the above strategies, special pelvic compression support garments can be worn.