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.

General 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.

Difficulty sleeping

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) . 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.

Skin changes
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.

Spider veins

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.

Increased pigmentation

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.

Stretch marks

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 invisible.

Breast problems
Breast tenderness

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 increases.

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 bring relief.

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.

Nipple problems

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).

Digestive problems
Nausea and vomiting

Approximately 80 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 gestational diabetes.

The “little and often” principle, coupled with healthy snacks is equally good advice for the late phase of pregnancy.

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