Pregnancy hormones affect every system in your body.
In this section, you will find a list of common concerns with an
explanation of the adaptation process that may cause these symptoms,
information on whether medical help is likely to be required, and advice
on measures you can take yourself to alleviate symptoms.
An overwhelming feeling
of fatigue is often one of the earliest signs of pregnancy. Such
feelings usually subside during the second trimester, but are likely to
return in the third trimester.
The main causes of
extreme fatigue in early pregnancy are massive hormonal changes and the
extra demands on the body made by an increase in blood volume of up to
50 percent. It’s this increase in blood volume that helps the lining of
the uterus to thicken and the placenta to develop. In the second
trimester, energy levels usually return to normal as hormone changes
settle down. Late in pregnancy, fatigue may recur because your extra
size and weight and the demands of the growing baby means that your body
systems need to work harder. In both early and late pregnancy,
difficulty sleeping an contribute to feelings of fatigue. Fatigue in pregnancy can also be caused by anemia.
What to do
If you are
working, take regular breaks and get some fresh air at least once a day.
Ensure that your fluid intake is adequate; caffeine is not helpful
because it dehydrates your body and will leave you feeling worse. Take
more time for sleep if you need to; housework can wait and you may need
to cut back on social commitments.
It’s very common to have sleeping difficulty in pregnancy, especially in the first and third trimesters.
A common cause of
disturbed sleep is the need to urinate frequently. Early in pregnancy,
this is due to the amount of blood in your body, leading to the kidneys
filtering out more fluid, which ends up in your bladder. As pregnancy
progresses, another factor is expansion of the uterus within the pelvic
cavity, so that it competes for space with the bladder. This leads the
bladder to require more frequent emptying, which will interrupt your
sleep. Many women also feel hungry during the night and need to snack,
while others find that nausea and vomiting interrupt their night or lead
to early waking. From about 20 weeks of pregnancy, the uterus moves up
out of the pelvis, taking pressure off the bladder, and nausea often
subsides, which means that sleep improves. Toward the end of pregnancy,
sleep patterns can once again be disturbed. Unborn babies are often
active just when you want to rest; your body is bulky and finding
comfortable sleeping positions becomes difficult; and as the baby
becomes bigger and heavier pressure on the bladder may return.
What to do
If frequent urination
is keeping you awake, don’t drink large quantities of fluid close to
bedtime, and to avoid waking up hungry include foods high in unrefined
carbohydrates, such as whole-wheat bread, in your evening meal. If you
do wake up, don’t lie there for long periods, since this is frustrating
and may lead to habitual sleeplessness. Get out of bed and engage in a
simple activity that won’t overstimulate your brain, have a warm,
caffeine-free drink, and return to bed when you’re sleepy. Later in
pregnancy when you find it difficult to get comfortable, experiment with
different sleeping positions: use plenty of pillows, under your head
and belly and between your knees. A rest during the day is essential
during late pregnancy, but limit this to a 20-minute power nap or an
hour reading or watching television with your feet up. If you sleep for
long periods during the day, you will further lessen your ability to
sleep at night.
Headaches are common in pregnancy, especially in the first trimester.
Most headaches are
unlikely to be a cause for concern and are probably due to hormonal
changes and the need for additional fluids. Headaches occurring in the
third trimester that are accompanied by other symptoms, such as
abdominal pain or nausea, may be a sign of preeclampsia and should be
assessed by a doctor .
What to do
Making sure you
drink enough clear fluids (around five cups a day) and avoiding caffeine
should help reduce the number and severity of headaches. If you’re
working or concentrating on a task, have a break every two to three
hours, and get some gentle exercise in fresh air. For a sinus headache,
apply a warm compress to the front and sides of your face. For tension
headaches, place a cool compress on the back of your neck. If you
suspect your headache is due to lack of sleep, get more sleep. And make
sure you’re eating enough, since hunger and low blood sugar can cause
headaches. Relieve stress—another headache trigger—with deep breathing,
meditation, yoga, or massage Always discuss your symptoms with your
doctor before taking medication.
If you have a
headache in late pregnancy that is accompanied by swelling of the legs
and ankles, generalized body swelling, abdominal pain, or nausea and
vomiting, contact your doctor immediately.
Swollen feet and ankles
Some women experience a
small amount of swelling in their feet, ankles, hands, and wrists, which
can be particularly pronounced in hot weather.
Swelling is the result
of fluid retention, which in turn results from the extra blood produced
during pregnancy to provide for the growing baby.
What to do
This is best
managed by alternating light activity with periods of rest during which
your feet are elevated. However, staying in bed or sitting in a chair
for very long periods may increase the risk of deep vein thrombosis
DVT is a potentially serious condition in which a blood clot forms in a
vein; if the clot breaks off, it may travel to the lungs and block a
major blood vessel. Swollen feet and ankles can also be a sign of other
problems such as preeclampsia, so should always be reported to your doctor who can check for other symptoms.
Itching and dry skin
Many pregnant women
suffer from itchy, dry patches of skin that worsen in late pregnancy.
Such skin irritation is a reaction to hormonal changes and can be eased
by a perfume-free moisturiser. Rarely, itching in late pregnancy may be
due to a serious condition called obstetric cholestasis. Itching caused by this condition is much more severe, usually constant, and often concentrated on the hands and feet.
Clusters of broken
capillaries (tiny red blood vessels) called spider veins may appear
during pregnancy, mainly on the cheeks. These occur as a result of
increased blood circulation and the softening effect of pregnancy
hormones on blood vessels. Spider veins are painless, but if you are
worried about their appearance you can cover them with makeup. They
usually disappear soon after the birth.
An increase in skin
pigmentation is common in pregnancy, probably due to the increased
production of hormones. Most women notice a darkening of the area around
the nipple (the areola), and a dark line, called the linea nigra,
forming vertically through the middle of the belly from the umbilicus to
the pelvis. Also common are dark patches on the cheeks, nose, and chin,
known as melasma (also known as chloasma, or the “mask of pregnancy.”)
On women with dark skin, the patches may appear lighter than surrounding
skin. Exposure to sunlight can make the patches more obvious, so use a
high-protection sunscreen on your face.
Rapid stretching of the
skin during pregnancy often leads to the development of pink or purple
lines, known as stretch marks. These marks, which can look quite
alarming, with a scarlike appearance, usually appear in late pregnancy,
commonly on the abdomen, hips, thighs, and upper breast. There is no
clear evidence that any cream will prevent or remove stretch marks,
although a light unscented moisturizer can help keep the skin supple, as
will staying well hydrated and avoiding excessive weight gain. As time
passes after the birth, stretch marks become silvery and almost
For many women,
breast tenderness and an increase in the size of their breasts are the
first signs of pregnancy. Sometimes breasts are so painful that you
can’t bear them to be touched, and they may also throb and feel hot.
Breast tenderness usually subsides by the end of the first trimester.
Tenderness is a sign
that the breasts are preparing for their role of feeding your baby after
the birth: the milk ducts are starting to enlarge and blood flow
What to do
Wearing a properly
fitting bra will help support your breasts and reduce discomfort. An
ill-fitting or tight bra will be uncomfortable and may put pressure on
the milk ducts. You may also find it helpful to wear a soft sleep bra at
night. If your breasts feel hot, applying a cool washcloth to them may
If you have a painful or red patch on a breast, you should report this to your doctor because it could be a sign of mastitis.
Each woman has
breasts and nipples individual to her. Women who have flat nipples that
do not protrude or whose nipples are inverted (concave) may worry that
they may not be able to breast-feed. However, all healthy women can
breast-feed because babies feed by taking in a mouthful of breast, not
just the nipple.
Inverted or flat
nipples are thought to be due to shorter ligaments in the underlying
breast tissue that pull the nipples inward.
What to do
If you have any
concerns about the suitability of your nipples for breast-feeding, talk
to your doctor who can refer you to a lactation consultant. There are
also products available that will draw out nipples in preparation for
breast-feeding. However, these are by no means essential because when
babies latch on to the breast they are able to draw out even a flat or
inverted nipple (although you may eventually need help by a lactation
consultant to show you the best way to help your baby do this).
Nausea and vomiting
percent of women are troubled by the unpleasant symptoms of nausea and
vomiting in early pregnancy. During this period it can be difficult to
eat large meals, and strong smells and tastes can become unbearable.
Many women also find some vegetable and acidic foods more difficult to
digest and worry that their usually healthy eating pattern has
deteriorated. Early pregnancy nausea and vomiting usually subside
between 12 and 20 weeks; however it’s not uncommon to experience some
return of these problems late in the pregnancy.
Early in pregnancy, the
pregnancy hormones interact with hormones that control other body
systems, particularly those involved with blood sugar regulation, and
this results in feelings of nausea and vomiting. Late in pregnancy,
problems with digestion may occur because the uterus takes up most of
the space in your abdomen, displacing your intestines and stomach and
leaving little room for the digestion of large amounts of food.
What to do
The best way to manage
the nausea and vomiting of pregnancy is to drink plenty of water
throughout the day and also eat small amounts of food on a regular
basis, which will help to avoid long gaps between meals, and snacking on
complex carbohydrates such as whole-wheat and whole-grain products,
whole-grain cereals, and brown rice dishes. Avoid snacks with a high
sugar content because, although these will give you a quick boost, they
will soon leave you feeling worse than before because your blood sugar
plummets. Reducing your overall intake of the refined sugar found in
candy, cake, cookies, and sugary drinks will help reduce the symptoms of
nausea and vomiting and will also lessen your risk of developing
The “little and often” principle, coupled with healthy snacks is equally good advice for the late phase of pregnancy.