09 Mar

breast discharge early pregnancy

The clear sticky liquid which may come out of your nipples in pregnancy is known as colostrum. Nausea also is related to human chorionic gonadotropin (hCG), a hormone that can be detected in the blood or urine even before a missed period. Estrogen is the hormone that is responsible for the development of breasts and milk ducts during pregnancy. Your vagina and cervix may get irritated during sex or a pelvic exam, which can lead to brown spotting or discharge. GoMedii is a facilitation engine which comes 1st in the patient treatment value chain and collaborates with all stakeholders of the ecosystem. Wondering if youre pregnant? So it is natural that some of that waiting colostrum could make its way out as nipple discharge. Vaginal discharge is common for female throughout the month. Vaginal discharge is a white, sticky liquid type substance that is released by pregnant women because of the thickening of the vaginal walls. Only 1 to 2 percent of pregnancies are ectopic, but it's important to get treatment immediately, because it's potentially dangerous for you. There are a few different types of nipple discharge, but the most common is milky discharge. 4 Easy Tips for Early Breastfeeding Success. Breast/nipple changes: With both early pregnancy and PMS, your breasts may be swollen, more sensitive and more tender. It's a small mass in the brain benign but it's there. https://www.cancer.gov/types/breast/paget-breast-fact-sheet. When a fertilized egg implants into the plush lining of the uterus about six to 12 days after conception, light vaginal spotting may occur. Ramped-up levels of progesterone slow down your digestive tract and may make your tummy feel puffier than usual. This is caused by the thickening of the cervical mucus and the increased blood flow to the area. Sore boobs are a common early sign of pregnancy, but they can also signify that your period is imminent. Vagina Quiz: What Do You Know About Down Below? Vulvovaginal health. Dizziness, lightheadedness, or feeling faint. If you experience any of these symptoms, contact your healthcare provider to determine the cause and to receive proper treatment, if necessary. Some women who are concerned about breast secretions may actually cause it to worsen. You should also note any changes in the appearance of your nipples or breasts. Not only can the swelling uterus put pressure on your bladder, but the extra blood flow to the kidneys (which begins right away) also causes them to produce more urine. While there may be an increase in vaginal discharge during pregnancy, this is not a sign of early pregnancy. "Needing to pee, all the time.". Understanding breast changes: A health guide for women. Breast swelling, size changes, or tenderness can be another very early sign of pregnancy. Fatigue. It may be thick and yellowish in color, though clear and white is also normal. While full-blown morning sicknesswhich affects up to 85% of all pregnant peoplelikely won't strike for a few more weeks, some may experience more subtle motion sickness as an early pregnancy symptom. Also Read: Vaginal Odour during Pregnancy: Reasons & Treatment 2. This rise in estrogen level also promptsthe blood flow to your pelvic area, which also leads to increase the discharge. You may experience a little heaviness in the breasts. ACR Appropriateness Criteria evaluation of nipple discharge. Like breasts themselves, breast pain comes in many varieties. Based upon your symptoms and the results of diagnostic tests, your doctor will decide on the best course of treatment. Bleeding or brown discharge can be a sign of vaginal or cervical infection, such as bacterial vaginosis (BV), trichomoniasis, chlamydia, or gonorrhea. In fact, some women notice breast tenderness as the very first sign of pregnancy. That said, keep in mind that most pregnant women who have spotting or bleeding in early pregnancy don't have a miscarriage. Accessed Oct. 9, 2019. Nipple discharge is a normal part of breast function during pregnancy or breast-feeding. Early in pregnancy hormonal changes might make your breasts sensitive and sore. Morning sickness, which can occur at any time of the day or night, often begins one to two months after you become pregnant. This pregnancy-friendly spin on traditional chili is packed with the nutrients your body needs when you're expecting. But extreme nipple sensitivity typically passes within a few weeks. Using her nursing background and 14+ years of experience teaching birthing classes, Katie has become an expert in the field of natural hospital birth. This is the good stuff. Hormone levels change rapidly after conception, which may cause your breasts to become swollen, sore or tingly. During your second trimester (weeks 1326), you may notice that your areolas the pigmented areas around your nipples have grown darker. These are some of the changes you may experience during the second and third trimesters of your pregnancy: Discharge. In fact, there are numerous common early signs of pregnancy to look out for, and a missed period is just one of them. Early pregnancy discharge But most pregnant women will secrete sticky, white, or pale-yellow mucus early on in the first trimester and throughout their pregnancy. Know About Female Reproductive System How Gynecologist Can Help? This increased discharge may also be due to the increase in blood flow to your pelvic area. https://www.womenshealth.gov/pregnancy/childbirth-and-beyond/labor-and-birth [Accessed March 2023], UC Davis Health. What's Normal and What's Not. Causes By Mayo Clinic Staff Nipple discharge is a typical part of breast function during pregnancy or breast-feeding. Your cervical tissues are particularly delicate during pregnancy, so you might notice some spotting or brown discharge after your practitioner has done a pelvic exam or checked your cervix. This typically occurs between weeks seven and eight."}}]}. Breast pain is often the first symptom of pregnancy, occurring as early as one to two weeks after conception technically, weeks three and four of pregnancy. Early in pregnancy, brown discharge might signal something serious, such as a miscarriage, ectopic pregnancy, or a molar pregnancy. National Cancer Institute. Your doctor will be able to determine whether the discharge is caused by pregnancy or another medical condition. National Cancer Institute: "Understanding breast changes: A health guide for women. So, yes, while some women experience nausea or hypersensitivity to smells, these seven symptoms are among the most common during the first few weeks of pregnancy. Early on, the alveoli (small sacs inside your breasts where milk is made) begin growing larger and increasing in number. Wipe from front to back after using the bathroom, and avoid using harsh soaps or douches. The soreness can be constant, or it can come and go. This is often due to an increase in the hormone prolactin, which produces milk. "You're making so much estrogen and progesterone in early pregnancy that the glands in the breasts start growing," explains Jasbir Singh, M.D., an OB-GYN at Baylor Medical Center at Waxahachie in Texas. While breast discharge is generally nothing to worry about, it can sometimes be a sign of a problem. "Fluctuating hormones tend to make headaches worse, and estrogen levels are more stable during pregnancy," explains Richard Gersh, M.D., an assistant professor of OB-GYN at Drexel University College of Medicine in Philadelphia. But try not to worry most of the changes your girls are going through are totally normal. Before your body starts producing the regular breast milk that will feed your baby, it producescolostrum, which is the real cause behind nipple discharge during pregnancy (1, 3). If youre not pregnant and youre not experiencing any other symptoms, its most likely that your period just hasnt started yet. 2021. Before we discuss nipple discharge, lets cover what happens to your breasts during pregnancy. Your breasts may be extra tender as early as one or two weeks after conception. In late pregnancy, your body is ready to feed your baby at any timeit is fully prepared to nourish your baby even if born premature. Sore boobs during pregnancy or before or during your period, for that matter is very common and generally nothing to worry about. National Cancer Institute. https://www.acog.org/womens-health/faqs/early-pregnancy-loss [Accessed March 2023], ACOG. a blocked or enlarged milk duct. Mayo Clinic Staff. If you notice one or two days of light spotting, but no normal period, this could indicate implantation bleeding and pregnancy. If you are pregnant, there are many things to look forward to, such as feeling the baby move, hearing the babys heartbeat, and finding out the babys gender. You may feel it all over, in a specific spot, or moving outward into your armpits. And you may notice red streaks known as you guessed it stretch marks. There are instances, though, when discharge from the breast may be a symptom of some forms of breast cancer. When to call the doctor for brown discharge during pregnancy, premature rupture of the membranes (PROM), the most helpful and trustworthy pregnancy and parenting information, Any bleeding or spotting (bright red or brown), Any vaginal discharge with a strong odor, or that's green or yellow and frothy. https://medlineplus.gov/ency/article/003158.htm [Accessed March 2023], OWH. There are normally 15-20 milk ducts . For women who aren't breastfeeding, the sight of nipple discharge can be alarming. Friction during sex can cause some trauma to your vaginal or cervical tissues, especially if you're not well-lubricated, and that can cause some spotting. This can put the health of you and your baby at serious risk. Usually, it is the result of growing milk ducts, but sometimes it can be a sign of a blocked duct. (People Also Like To Read: Know About Female Reproductive System How Gynecologist Can Help?). Having thick or milky white vaginal discharge usually around the time of a missed menstrual period is often among the first typical early pregnancy symptoms. You might mistake this "implantation bleeding" for the start of your period, but it's generally lighter than menstruation and brown or pink (instead of red) in color. "My nipples were darker and a bit bumpy.". Last medically reviewed on July 15, 2019. But it can also be a sign of a problem, such as a vaginal infection. First Da Capo Press, The American College of Obstetricians and Gynecologists. As the first trimester progresses, you may notice fullness and heaviness rather than tenderness. If you are in your childbearing years and one week or more have been passed without the start of your expected period, then you may be pregnant. Obstetrics & Gynecology. The test findings may be skewed by the fact that diluted urine frequently also has diluted hCG levels."}}]}. Here's what you need to, Your changing hormones and shape can lead to some common and not-so-common aches and pains during pregnancy. Make an appointment to your gynecologist if you notice any abnormal vaginal discharge. And it causes you to hve milk in breast even though you aren't pregnant or nursing. This can cause infertility as well if not probably treated. (2017). Cramping and discharge are common early signs of pregnancy, but they can also be caused by other conditions. My suspected date is May 18. Why Bleeding During Pregnancy Doesn't Always Mean Miscarriage. Practice Bulletin No. All rights reserved. Breast discharge is often thin and milky, and it can vary in color from white to yellowish green. You may notice an increase in white creamy discharge early in pregnancy, due to higher levels of estrogen. ", American Academy of Family Physicians: "Galactorrhea.". Colostrum is produced from around the middle of your pregnancy until your baby is a few days old. That sore boob sensation. ", University of Michigan Health System: "Nipple discharge. Things like missing your period, sore or tender breasts, feeling more tired and nausea (morning sickness) are common symptoms of early pregnancy. Increased blood volume may trigger frequent but mild tension headaches as an early sign of pregnancy. Background: The World Health Organization (WHO) recommends early initiation of breastfeeding (EIBF) within the first hour after birth. Pregnant women may lactate as early as the second trimester and may continue to produce milk for up to two years after cessation of breast-feeding. While nipple discharge is a common occurrence during pregnancy, it is not always a sign of pregnancy. The #1 app for tracking pregnancy and baby growth. It may cause the nipple and the surrounding areola to bleed or ooze. Is It Implantation Bleeding or Your Period? These hormones can cause the mucous membranes in your vagina to become thicker and more mucous-like. These symptoms are sometimes similar to the sensations in the breasts in the days before an expected menstrual period. You may notice that you can see veins under the skin of your breasts, which is a result of the increased volume of blood in your body. Other symptoms include severe nausea and vomiting, abdominal cramping, and pelvic pressure or pain. I would mention it to your doctor. The discharge associated with a papilloma often occurs spontaneously and involves a single duct. Sore breasts are common in early pregnancy due to fluctuations in hormones. Nonlactational mastitis. And hormones stimulate the growth of milk-producing glands. However, in some cases, nipple discharge can be a sign of a more serious condition, such as breast cancer. 1. Sore Nipples (and Sore Breasts) One of the first signs of pregnancy for many women is sore breasts with very tender nipples. Healthline Media does not provide medical advice, diagnosis, or treatment. The sensation may feel similar to a painful pimple, which is also caused by a clogged gland. What might cause normal nipple discharge? Lower back pain, breast tenderness. During the first few weeks, your body is working 24/7 to support the pregnancy, and fatigue is a normal response. Its important to talk to your doctor about any concerns you have and get regular prenatal care. Brown discharge can be normal, for example if you bleed a bit after sex or a pelvic exam. Nipple discharge is not considered a common symptom of pregnancy, but it can occur. In fact, it is estimated that around half of all pregnant women will have some discharge from their breasts during pregnancy. Understanding Your Pregnancy Emotions and Mood Swings, Basal Body Temperature and Ovulation: How to Track Your BBT. Nipple discharge is a common occurrence during pregnancy, and it can be caused by a number of different factors. About 1 in every 1,000 pregnant women develop breast cancer. Some women also experience a tingling sensation in the nipples and areolas during the first trimester. And don't forget that stellar combo of headaches, bloating, constipation, and breast painneed we say more? "All day . "Implantation bleeding is sort of a diagnosis of exclusion.". You may also need a biopsy to confirm that it's a papilloma or to exclude a cancer. Breast changes in early pregnancy can lead to tenderness and soreness and severe discomfort. Gary, R. American Journal of Surgery, December 2007. Kopa Birthsonline birthing classesallow you to prepare for a natural hospital birth from the comfort of your own home, 24/7. This condition develops in the ducts of the breast and then moves to the nipple. Like a period eaxh month. Known as leukorrhea, this thick, milky white discharge during early . According to research, newly pregnant women have a sufficient amount of Human Chorionic Gonadotropin (hCG) after seven to ten days of ovulation. Your heart also pumps faster, as it has to deliver extra oxygen to the uterus; this, too, can make you feel tuckered out. U.S. Office on Women's Health. In the early stages of pregnancy, some women notice clear breast discharge coming from their nipples. ","acceptedAnswer":{"@type":"Answer","text":"Avoid consuming excessive amounts of liquids before a pregnancy test, including water. In some women, breast tenderness or swollen breasts and nipples may last through the first trimester. Your breasts will likely grow larger and heavier. Diarrhea or nausea. Plugged milk ducts Consuming turmeric in pregnancy is a debated subject. This type of vaginal discharge is known as leukorrhea. So easy and delicious. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Give today to find cancer cures for tomorrow, Common questions about breast cancer treatment. That sore boob sensation peaks in the first trimester because your body is flooding with hormones. 2005-2023 Healthline Media a Red Ventures Company. Most pregnant women dont experience discomfort with nipple discharge, other than the possibility of feeling a little damp. Often, nipple discharge stems from a benign condition. While some women do experience pregnancy symptoms earlier than others, the only way to confirm a pregnancy is with a test. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. If you're seeking a preventive, we've gathered a few of the best stretch mark creams for pregnancy. Pregnancy also causes the breasts to get heavier and swell a bit . Barratt, J., Cross, C., Steel, S., & Biswas, C. (2016). Nipple discharge is a typical part of breast function during pregnancy or breast-feeding. Karen Miles is a writer and an expert on pregnancy and parenting who has contributed to BabyCenter for more than 20 years. https://www.acog.org/patient-resources/faqs/womens-health/vulvovaginal-health [Accessed March 2023], March of Dimes. "Darker-complexioned women may not notice this until later in pregnancysay, around 10 weeks or so," says Melissa M. Goist, M.D., Assistant Professor of Obstetrics and Gynecology at The Ohio State University Medical Center. Ways to promote labor. Increased vaginal discharge is caused by the increase in estrogen levels during pregnancy. Besides an increase in vaginal discharge, observing a cervical mucus plug may be among the early pregnancy signs. 2005 - 2023 WebMD LLC. Some women dont experience any nipple discharge during pregnancy. Tender, swollen breasts. The simple answer is that your breasts fill with liquid during pregnancy, and sometimes that liquid makes it way out. In the second trimester, vaginal discharge is milky egg white in colour and consistency.It is considerably more frequent than the discharge in the first trimester but is perfectly normal as it occurs due to the hormones cascading through a woman's body. Increasing blood volume puts more pressure on delicate vessels like the ones in your nose, but hormones are to blame too, Dr. DeNicola says. Hope this helps and doesn't scare you. Never douche as it disrupts the normal balance of good bacteria in the vagina. Luckily, much of the discomfort can be relieved by using a simple saline spray, and it should resolve soon after delivery. Join Katie on her own birth journey to learn all you need to know to be calm, prepared and confident during your natural birth. In the final weeks of your pregnancy, you may notice that your breasts have become even larger and heavier than before. Some breast and nipple discomfort is normal with pregnancy. During your first trimester, you may also notice blue veins pumping extra blood into your breasts and changes to the size or shape of your nipples. Breast pads are just circular pads, either disposable or washable, that go inside your bra. Paget's disease usually occurs with another form of breast cancer. Can white vaginal discharge be an early pregnancy symptom? It starts to change during the early stages of pregnancy. During the second and third trimesters you may also begin leaking a yellowish fluid called colostrum. Color isn't usually helpful in deciding if the discharge is normal or abnormal. Try to use panty liners it can make you feel more comfortable during pregnancy. (Blood turns brown as it dries, and blood can sometimes take a while to come out.). Breast changes . Most of the time placental abruption causes vaginal bleeding or spotting. I have been having breast discharge for a few weeks. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/galactorrhea#v980911. The higher the hCG level, the sicker you may feel. What Is Normal Pregnancy Discharge? If the discharge increases significantly or changes in color or odor, you should contact your doctor. "The overwhelming majority of pregnant people with brown discharge don't have anything dangerous to be worried about.". Golshan M. Nipple discharge. You may wonder if its normal and why it happens. About 30% of pregnant people experience cramping after conception, which is triggered by implantationwhen the fertilized egg attaches to the uterine wall. To feed that hunger, hormones work quickly to prepare your breasts for breastfeeding. But if you see any unusual signs of discharge then you should consult to your gynecologist as soon as possible. That includes your digestive processes, sometimes resulting in constipation or indigestion. What Causes Abdominal Pain During Pregnancy? Already gotten those two pink or blue lines on a home pregnancy test? This likelihood is greater if your nipple discharge is accompanied by a lump or mass within the breast or if you have had an abnormal mammogram. So what should you do? Our website services, content, and products are for informational purposes only. "Progesterone is the major hormone at play in the early stages of pregnancy, but there is the circulation of other hormones that help with the relaxation of muscles, so in those settings, some women get back pain and the like," Dr Sgroi said. Which Is The Preferred Measure For Demographers To Estimate Future Fertility? Lets learn more! There usually aren't symptoms, though the most common symptom is bleeding in the second half of pregnancy, as your cervix begins to open up and disrupt the blood vessels in the area. Sore nipples may be a sign of ovulation for some people. Breast tenderness is often one of the earliest symptoms of pregnancy. Bonus: You can. https://www.uptodate.com/contents/vaginal-discharge-in-adult-women-beyond-the-basics [Accessed March 2023]. Normal nipple discharge more commonly occurs in both nipples and is often released when the nipples are compressed or squeezed. This is especially true if youre someone who typically experiences breast pain during PMS. Although all this may sound horrifying and potentially pretty embarrassing if it happens at the wrong time leaked fluid and discharge actually happen in really small amounts. signs of discharge then you should consult to your gynecologist as soon as possible. Journal of the American College of Radiology. Since the tissue in your breasts is incredibly hormone sensitive, they swell and feel a. Most women experience some type of discharge during early pregnancy. Enroll today in ourfree online childbirth classand start preparing for your natural birth! Breast changes. If you have other symptoms, such as pain or fever, its important to see a doctor to determine the cause. 2021. It is a very common breast symptom and in most cases is part of the normal function of the breast rather than being caused by a problem. The most common cause of breast discharge during pregnancy is the increase in the level of estrogen in the body. Cramping And White Discharge During Early Pregnancy, Missed Period Light Brown Discharge Negative Pregnancy Test, Curd Like Discharge Is A Sign Of Pregnancy, What Does Discharge Look Like In Very Early Pregnancy. . This can start as early as two weeks after conception. Because your digestive tract is slowing down now, says Dr. Goist, food may not pass through as quickly. From the very start of your pregnancy, with the change of hormones that accompany it, your breasts begin preparing to feed your baby (1, 2). "In the first trimester, bleeding should be evaluated for three things in particular: miscarriage, an ectopic pregnancy, or certain types of infections," Dr. Singh says. It may also be associated with menstrual hormone changes and fibrocystic changes. Your Pregnancy and Childbirth Month to Month, 5th edition, Anatomy of the Breast. Kopabirth.com is the culmination of her thousands of hours of research and observation, and all posts are current and evidence-based. 5) See your doctor if you have any concerns. Miscarriage is most common in the first trimester, though it can happen anytime up to 20 weeks. Vaginal itching and discharge adult and adolescent. Keep in mind that every pregnancy is different, so you may not experience all of these things. 1) Keep your genital area clean and dry. 2020. Lee SJ, et al. The signs of labor can differ from one woman to another, and even for . Your nipples and areolae (the circle of darker skin around the nipple) may become darker and larger. What causes breast milk discharge? The cleavage may be pretty great but this growth can also be painful, even causing skin irritation and itching. Both abnormal and normal nipple discharge can be clear, yellow, white, or green in color. They can preform a comprehensive exam and help you know if what youre experiencing is normal or not. Yes, it is common to have a pinkish brown discharge in early pregnancy. Before your body starts producing the "regular" breast milk that will feed your baby, it produces colostrum, which is the real cause behind nipple discharge during pregnancy (1, 3). Check out the video, and watch Dr. Alexandra Sowa explain. Sure, most of us know that milk may leak from our breasts after the baby is born. These headaches can also happen if you aren't drinking enough fluids or if you're anemic, so be sure to get your blood work done to rule out the latter. The discharge might also look thick or lumpy, have a bad smell or be accompanied by other vaginal symptoms like itching or burning. Using semi-structured interviews over the telephone the effects of 'voluntary' and 'involuntary' early postnatal discharge on women's experiences of early discharge and breast feeding rates were studied in a sample of 230 women. . Well, whats frustrating is that sore boobs can occur for so many different reasons. Placenta previa means that your placenta is lying unusually low in your uterus. "As levels of hCG hormones increase, you're feeling massive amounts of fatigue, which makes you more prone to moodiness," says Dr. Goist. You can just seek for some remedies to reduce the discomfort. Galactorrhea may occur if you take sedatives or marijuana. Advertising revenue supports our not-for-profit mission. Many people mistake these early signs of pregnancy for PMS symptoms, but they're actually caused by hormonal changes and the growth of the uterus. White discharge sign of . The extra discharge is due to a boost in estrogen production and increased blood flow early in pregnancy, she says. The swelling, which signals an increase in fat reserves and milk gland size, may be accompanied by soreness. Paget disease of the breast. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Smoking Pot Every Day Linked to Heart Risks, Artificial Sweetener Linked to Heart Risks, FDA Authorizes First At-Home Test for COVID and Flu, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox. Feelings of breast swelling, tenderness, or pain are also commonly associated with early pregnancy. Breast Cancer In Young Women: A Journey That Requires Extra Support Breast cancer affects young women in many ways: from the battle to receive a diagnosis . When it does, it can cause the bursting of small blood vessels and a small amount of vaginal bleeding. Learn more about our editorial and medical review policies. It is seen to get eternity until you didnt get the positive test. Sleeplessness. The symptoms of early pregnancy are very similar to the symptoms of your regular period. In many of these instances, you'll most likely notice red bleeding, but it's possible the blood might appear brown. One form of breast cancer that may cause breast discharge is intraductal carcinoma. Common causes include: breastfeeding or pregnancy - see leaking from your nipples. Here are the likely causes of brown spotting or brown discharge while you're pregnant. What are the five most common early signs of pregnancy? Breast discharge is the spontaneous flow of fluid from the nipple at any time other than during nursing. It may also be associated with menstrual hormone changes and fibrocystic changes. It is similar to everyday discharge, meaning that it is thin, clear or milky white, and smells only mildly or not at all.. HCG Levels Chart: Are They Necessary While Pregnant? The tests will help determine the underlying condition that's causing the problem and may include one or more of the following: Possible causes of abnormal discharge include: Most nipple discharge is either normal or caused by a benign medical condition. A pregnant woman will often experience a variety of changes to her body, including an increase in discharge. (n.d.). These are called Montgomerys tubercles. Nipple discharge. In the later stages of. You could have some brown, blood-tinged discharge after sex. Sharp breast pain which can feel like a knife being stabbed into a specific area of one breast isnt common during pregnancy. Implantation Bleeding: All About the Early Sign of Pregnancy, Everything You Need to Know About Implantation Cramps, 11 Pregnancy Symptoms You Shouldn't Ignore, Swelling During Pregnancy? But if you notice discharge from your nipple, there's no reason to panic.

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breast discharge early pregnancy