What does stomach pain during pregnancy mean?

Abdominal pain during pregnancy can be a source of concern for many expectant mothers, prompting questions about its cause, severity, and potential impact on both maternal and fetal well-being. However, there are many common causes of stomach pain during pregnancy (beyond morning sickness) that are relatively benign and will likely resolve without medical intervention. Knowing what they are and how they present can help reduce anxiety if you encounter any of these conditions.

Is it normal to have stomach pain during pregnancy?

It’s completely normal—and very common—to have stomach pain during pregnancy. Many causes are nothing to worry about, just a typical part of gestation. However, there are a few more serious conditions that can cause a bellyache when you’re expecting, such as appendicitis or gallstones. 

“While many causes of abdominal pain in pregnancy are normal due to physiologic changes that occur during pregnancy, abdominal pain that is unrelenting and/or severe in nature or accompanied by vaginal bleeding, fever, chills, nausea and/or vomiting warrant more immediate evaluation by your healthcare provider,” says Alexandra Loza, DO, maternal-fetal medicine specialist at Hartford HealthCare in Hartford, Connecticut. 

Read on to learn which types of symptoms can be managed by something as simple as adding a little more fiber to your diet—and which merit a visit to your OB-GYN. 

6 common causes of stomach pain in pregnancy

The more common causes of abdominal pain can usually be identified by their self-limiting nature, according to Dr. Loza. This means that if pain resolves spontaneously, with rest, hydration, over-the-counter medications, or lifestyle modifications, the cause of the pain is most likely benign. Here are 6 common causes of stomach pain during pregnancy.

1. Acid reflux

Heartburn, or gastroesophageal reflux, occurs when stomach acid moves upward from your stomach into the back of your throat. GERD can feel like a burning sensation in your chest (heartburn), which is most common after eating or while lying down. It can also feel like pain in your upper abdomen or chest. Sometimes, GERD can also cause difficulty swallowing or a feeling of a lump in your throat. 

“Gastroesophageal reflux (or GERD) is more common in pregnancy because progesterone, the main hormone produced during pregnancy, ‘relaxes’ the lower esophageal sphincter, allowing stomach acid to travel up from your stomach into your esophagus,” Dr. Loza says.

Initial management of GERD consists of lifestyle and dietary modification: elevation of the head after eating, avoidance of large meals, maintaining a healthy weight, and avoidance of dietary triggers. If symptoms persist, pharmacologic therapy should begin with antacids or sucralfate (1 g orally three times daily). For those who don’t find relief, evaluation by your healthcare provider or referral to a gastroenterologist may be necessary to rule out more serious causes, says Dr. Loza.

2. Constipation, gas, or bloating

Constipation occurs when you have fewer than three bowel movements per week or anytime you have hard, difficult-to-pass stools. The slow movement through your intestines can lead to bloating or gas pains, which can feel like cramping, discomfort, or fullness in your abdomen.

“Constipation, gas, and bloating are common throughout pregnancy and are likely caused by hormonal factors (for example, progesterone slows gastrointestinal motility) and mechanical factors (pressure of the gravid uterus on the colon),” Dr. Loza says. “Oral iron, found in prenatal vitamins, is another common culprit.”

According to Dr. Loza, management for constipation includes increasing water and dietary fiber intake or using bulk-forming laxatives or saline enemas. For occasional constipation, magnesium hydroxide can be used. 

3. Round ligament pain

Round ligament pain is discomfort that occurs as the uterus enlarges during pregnancy. It is usually mild and feels like cramping, pulling, stabbing, or aching in the lower abdomen, pelvis, hips, or groin area. The pain typically lasts for a few seconds and is brought on by sudden movements such as standing or sitting quickly, turning from one side to another in bed, sneezing, coughing, or laughing.

“While round ligament pain often occurs in the late first trimester, it is usually more pronounced during the second trimester as the uterus grows and the surrounding ligaments connecting the uterus to the pelvic sidewall are stretched,” Dr. Loza says.

RELATED: Causes of round ligament pain during pregnancy

4. Fetal position or movement

Most will start feeling the fetus move between 16 and 24 weeks of pregnancy. It’s normal to feel pressure when the fetus is in certain positions or to feel it move or kick. Sometimes, this also causes back pain.

Fetal movement can feel like butterflies in your stomach or a rolling or swirling movement. As the fetus grows, you may feel pressure or kicking depending on the position the fetus is in or whether it is kicking.

If you’re experiencing symptoms of fetal movement, try to change positions. While it may take some trial and error to find the right position to alleviate stomach or lower back pain, your movement can trigger the fetus to move. 

5. Braxton Hicks contractions

Braxton Hicks contractions are commonly referred to as “false labor” or “practice contractions.” Most common in the third trimester, Braxton Hicks contractions often feel like abdominal cramps or tightening that comes and goes. It’s important to note that Braxton Hicks contractions don’t increase in length, nor do they get more intense over time.

“These contractions are typically mild in nature and resolve spontaneously or with conservative measures such as rest and hydration,” Dr. Loza says. “They can be felt as early as the second trimester and usually occur after periods of more intense physical activity (including intercourse) or if you become dehydrated.”

To manage Braxton Hicks contractions, take a lukewarm bath or use a warm compress or a heating pad. Ensure the temperature is comfortable but not hot so your body temperature doesn’t rise. If you have questions about using a heating pad during pregnancy, consult your healthcare provider.

6. Urinary tract infections (UTIs) 

UTIs are common in pregnant women due to changes in the urinary tract that occur during pregnancy. As the fetus grows, the bladder gets squished and may not completely empty, and the remaining urine may become infected. While symptoms from a UTI most commonly include back or pelvic pain during urination and increased frequency or urgency of urination, they can also cause stomach pain. It’s important to seek treatment if you believe you may have a UTI. Luckily, they’re usually easy to treat with a pregnancy-safe antibiotic.

RELATED: Your guide to UTIs during pregnancy

6 serious causes of stomach pain in pregnancy

If a pregnant person is experiencing more severe pain in the abdomen, it could indicate something more severe—which requires prompt medical attention. If your stomach pain is more severe than the common causes discussed, or it’s accompanied by any of these symptoms, it may be time to seek medical attention: 

• Fever
• Low blood pressure
• Moderate or severe abdominal or pelvic pain
• Nausea or vomiting
• New onset high blood pressure
• Vaginal bleeding

More serious causes of stomach pain include:

1. Appendicitis

Appendicitis is a condition that occurs when the appendix becomes inflamed. It’s fairly rare during pregnancy but is dangerous when it happens because the symptoms are often misdiagnosed as another type of pregnancy stomach ache—like round ligament pain or morning sickness—which increases the risk of complications. When appendicitis causes a rupture in the appendix, fecal contents and bacteria enter the abdominal cavity, and this can be life-threatening. 

The hallmark symptom of a typical appendicitis is a sharp pain in the lower right abdomen, often with fever, nausea, or diarrhea. During pregnancy, you may feel the pain higher up (because the fetus has displaced the appendix) or as a stabbing pain in the center of your stomach before migrating to the right side. Movement often makes the pain more severe. The treatment for appendicitis during pregnancy is laparoscopic surgery and removal of the appendix.

2. Ectopic pregnancy

Ectopic pregnancy is a condition that occurs after an egg and sperm meet, become fertilized, and grow outside the uterus, most commonly in a fallopian tube. Signs of an ectopic pregnancy include sharp abdominal pain and unusual vaginal discharge. Most people are diagnosed with ectopic pregnancy by eight weeks, but it can be diagnosed anytime during the first trimester by blood work and an ultrasound. The treatment for ectopic pregnancy is abortive medication or surgery to remove the pregnancy. An ectopic pregnancy cannot progress to a normal pregnancy, and a full-term fetus is not possible. When an ectopic pregnancy outgrows its blood supply or space within the fallopian tube, it ruptures and is a life-threatening condition for the mother.

3. Gallstones

Gallstones occur when bile hardens and becomes lodged in the gallbladder. Your risk of developing gallstones increases during pregnancy because of hormonal changes. Nearly 8% of pregnant women develop gallstones by their third trimester. Symptoms include pain in the right upper abdomen or shoulders, nausea, vomiting, fever, light-colored stool, or jaundice. Pain medication and intravenous fluids can be used to treat gallstones during pregnancy, but sometimes surgery is needed to remove the gallbladder.

4. Placental abruption

Placental abruption occurs when the placenta, the sole source of nutrients and oxygen for the fetus, becomes detached from the uterus. This disrupts the flow of oxygen and nutrients to the baby and can be life-threatening to the mother. The most common symptoms of placental abruption are vaginal bleeding, severe abdominal pain, and uterine contractions. This pregnancy complication is most common in the last few weeks of pregnancy before birth. It requires immediate delivery of the baby along with medication and blood transfusions if the bleeding is severe.

5. Preeclampsia

Preeclampsia is a condition characterized by high blood pressure and protein in urine. It can cause right upper quadrant abdominal pain. However, it often has no symptoms, so it’s important to schedule regular checkups throughout your pregnancy so your provider can check your blood pressure and urine. Medication or inducing delivery are used to treat preeclampsia, depending on the severity and your stage of pregnancy.

6. Preterm labor

Preterm labor is any labor that occurs between 20 and 37 weeks gestation. Symptoms include pelvic pain and contractions that don’t go away and intensify over time. Your healthcare provider may use medication to try to stop the preterm labor or administer steroids to help the fetus’s lungs develop more quickly before delivery.

Bottom line: What to do about stomach pain in pregnancy 

While it’s always important to maintain open and transparent communication with your healthcare provider, doing so during pregnancy is crucial. If you experience any of these symptoms, contact your healthcare provider to determine whether a formal evaluation is necessary. Physicians always have someone available to take patient calls. If there is an issue, call your provider for help. Particularly, be sure to call if you have a stabbing pain that doesn’t go away or intensifies and is accompanied by nausea, fever, or vaginal discharge—as these are signs of a more serious condition. When in doubt, head to the emergency room attached to a hospital that delivers babies to get checked out.