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Calculating your due date

This interactive Due Date Calculator will help you estimate the date your baby will arrive. Pregnancy usually lasts 280 days (40 weeks) from the first day of the woman's last menstrual period. This calculator is a general guide: every pregnancy is unique, and sometimes babies arrive sooner or later than expected. Always talk to your health care provider about your due date.

Once you're pregnant, be sure to have regular checkups by a doctor, certified nurse-midwife or other health care professional during the course of your pregnancy. The goal of prenatal care is to monitor the progress of a pregnancy and to identify potential problems before they become serious for either the mother or the baby.

Fertilization of the egg usually takes place 14 days before the woman's next period. If your menstrual cycle is shorter or longer than 28 days, select the number of days from the start of one cycle to the start of the next cycle.

Most common questions

Abdominal pain or cramping

Some short-term achiness in the belly is normal during pregnancy. But, severe cramping or pain never is. Call your health care provider when you show signs of severe pain.

Causes of normal abdominal pain during pregnancy
There are different causes for mild achiness or pain in the abdomen during the different stages of pregnancy.

Implantation

  • Many women have low, period-like pain or cramps for a day or so early in pregnancy.
  • This usually happens around the time the embryo is embedding itself in the lining of the uterus.

Stretching of ligaments

  • In the second trimester, the muscles and ligaments (tough bands of tissue) that support your uterus stretch.
  • This can cause a dull ache across the belly or a sharp pain on one side. Many women feel this pain most severely when getting up from a bed, chair or bathtub or when coughing.

False labor

  • In the second and third trimesters, you may feel contractions or an irregular tightening of your uterus muscles, often called Braxton-Hicks contractions or false labor.
  • False labor is usually painless, but some women feel pain.
  • False labor tends to increase in the weeks right before your due date and can be confused with early labor.
  • You are probably having false labor if the contractions stop when you walk, are irregular and don't get stronger or closer together over time.

Cramping

  • In the last weeks of pregnancy, cramping may be a sign that labor is almost ready to begin.
  • At the start of labor, you may have strong cramps that come regularly every 5-10 minutes and feel like a bad backache or menstrual cramps.
  • Normal abdominal pain may also be caused by gas pains and bloating caused by hormones that slow your digestion, the pressure of your growing uterus, constipation and heartburn.

What you can do
When you feel abdominal achiness, sit down, put your feet up and relax. Resting comfortably should quickly relieve your symptoms. Other tips include:

  • Avoid quick changes in position, especially turning sharply at the waist.
  • When you do feel a pain, bend toward the pain to relieve it.
  • Walking, doing light housework or changing position may help relieve gas pains.
    Put a hot water bottle wrapped in a towel or a heating pad on the lowest setting on your belly.
  • Take a warm bath or shower.
  • Make sure you are getting enough fluids.

When to talk to your health care provider

Severe pain
While some pain or achiness is normal, severe abdominal pain or cramps could be a sign of a serious problem. Many conditions can cause this type of pain, whether you're pregnant or not. Severe pain may be a sign of stomach virus, food poisoning, appendicitis, urinary tract infection, kidney infection, kidney stones, gallbladder disease or complications of pregnancy (such as preeclampsia).

Contact your provider if you have severe and continuous pain, or if you also have:

  • Cramps
  • Bleeding or discharge from your vagina
  • Fever
  • Chills
  • Lightheadedness or faintness

Ectopic pregnancy
During the first 3 months of pregnancy, abdominal pain can be a sign of ectopic pregnancy. An ectopic pregnancy occurs when the fertilized egg is implanted outside of the uterus. This serious condition requires immediate medical attention. Call your health care provider right away if you notice slight, irregular vaginal bleeding a week or more after you miss your period. The bleeding is often followed by pain in the lower abdomen, usually on one side. Without treatment, the pain will get worse and may be accompanied by shoulder pain, faintness or dizziness, nausea or vomiting.

Preterm labor
Before the 37th week of pregnancy, abdominal cramping can be a sign of preterm labor. Call your health care provider or go to the hospital right away if you have any of the following:

  • Contractions (your abdomen tightens like a fist) every 10 minutes or more often
  • Change in vaginal discharge (leaking fluid or bleeding from your vagina)
  • Pelvic pressure—the feeling that your baby is pushing down
  • Low, dull backache
  • Cramps that feel like your period
  • Abdominal cramps with or without diarrhea

Labor
You'll know you're in labor when you feel frequent and regular contractions—the only true sign that labor has begun. Call your health care provider when:

  • Your contractions are between 5 and 10 minutes apart.
  • Your water breaks, especially if the fluid is stained dark, greenish brown.
  • You have bleeding from your vagina.
  • You can no longer walk or talk during contractions.
  • You are concerned about your health or the health and well-being of the baby.

June 2009

Backache

Backache is one of the most common problems for pregnant women. Nearly half of all women have back pain at some point during pregnancy. There are three types of back pain related to pregnancy:

  1. Low-back pain when you stand or sit
  2. Pain that is worst in the back of your pelvis and deep in your buttocks
  3. Pain in your lower back when you are in bed at night

Back pain can be caused by:

  • The strain on the back from carrying the extra weight of pregnancy
  • Changes in posture to offset the extra weight of pregnancy. This shifts your center of gravity forward and puts more strain on the lower back.
  • Strain on the weakened and stretched muscles in the abdomen that support the spine

Although some amount of backache is normal, severe back pain is not. It can be a warning sign of infection or complications, especially when a woman also has fever or other symptoms.

What you can do
You can lessen some of the normal back pain encountered during pregnancy by following these tips:

Posture

  • Be aware of your posture.
  • Try to keep your hips pulled forward and your back straight. Don't be a "sway back."

Footwear

  • Wear low-heeled shoes with good arch support.
  • Avoid wearing high heels. They can strain your lower back muscles.

Lifting

  • Avoid lifting heavy objects. This can put even more strain on your back.
  • If you must pick something up from the floor, squat down, bend at the knees and keep your back straight. Do not bend over from the waist.

Carrying

  • Split larger loads into two smaller loads. Holding them in either hand may be easier than carrying one large load.
  • If you must carry a large object, keep it close to your body.

Bending and stretching

  • Keep objects you need close by so you don't have to bend or stretch to pick them up.
  • Be careful. It's easy to lose your balance when you are pregnant.

Standing

  • Avoid standing for long periods of time, if possible.
  • If you have to stand for an extended period, rest one foot on a stool or box. This will help relieve the strain on your back.

Sitting

  • Sit in chairs with good back support.
  • Tuck a small pillow behind your lower back for extra support while sitting.

Sleeping

  • A firm mattress provides better back support than a soft one.
  • If your mattress is too soft, a board between the mattress and box spring will make it firmer.
  • Sleep on your side instead of your back.
  • Tuck a pillow between your legs when lying on your side. The pillow will help straighten your spine and give extra support to your back.

Support

  • Look for maternity pants that have a wide elastic band to be worn under the curve of your belly. This band will help support the extra weight.
  • Consider using special abdominal-support girdles. They can provide back support and are available in maternity stores.

Heat or cold

  • Apply a heating pad set to the lowest temperature, a hot water bottle filled with warm water or a cold compress.
  • To avoid excessive cold or heat, wrap the heating pad, hot water bottle or compress in a towel.

Light massage

  • Try gently rubbing or kneading the sore areas of your lower back. Ask your partner or a friend to help.
  • Consider getting a massage designed for pregnant women.

Pain relief

  • Medication to treat back pain during pregnancy is usually not a good option.
  • Always check with your health care provider before taking any type of medication.

Exercises

  • Certain exercises can help strengthen and stretch your back muscles.
  • They can also improve your posture and strengthen your abdominal muscles for labor and delivery.
  • Talk with your health care provider about which exercises are safe for you and how long you should keep doing them during pregnancy.

June 2009

Breast changes

Almost as soon as you get pregnant, you'll notice changes in your breasts. These changes are normal as your breasts get ready to feed your baby after pregnancy.

Common breast changes during pregnancy

Tingling, swelling, sensitivity or tenderness

  • For many women, tenderness in the breasts is one of the first signs of pregnancy.
  • It is caused by increased amounts of female hormones in your body.
  • Your breasts may also tingle with temperature change.

Larger breast size

  • During early pregnancy, fat builds up in the breasts. The milk glands increase in size.
  • By six weeks, your breasts may be noticeably larger—by as much as a full cup size or more.
  • Your breasts may keep growing in both size and weight throughout the first three months of pregnancy.

Itchiness and stretch marks

  • As your breasts grow, the skin will stretch.
  • You may feel itchiness or develop stretch marks.

Larger veins

  • During pregnancy, there is an increased supply of blood to the breasts.
  • This may cause bluish veins to appear just under the skin.

Darker nipples and areolas

  • The nipples will grow darker and may stand out more.
  • The areolas (the skin around the nipples) darken and grow larger.
  • The small glands on the surface of the areolas become raised and bumpy.
  • These bumps produce an oily substance that keeps your nipples from cracking or drying out.

Leaking

  • By 12-14 weeks of pregnancy, some women find that their breasts are leaking a fluid.
  • This fluid is colostrum (the fluid that nourishes your baby for the first few days after delivery before your breasts start to make milk).
  • Colostrum may leak on its own or may leak during breast massage or sexual arousal.
  • Early in pregnancy, the colostrum is usually thick and yellow. As delivery approaches, it turns pale and nearly colorless.

What you can do
You may not be able to reduce soreness or tenderness in your breasts. But you can do some things to ease some of the discomfort.

Support bra

  • A good maternity bra can provide some relief. It will also support your back muscles.
  • As your breasts get larger, make sure your bra fits well and doesn’t irritate your nipples.
  • Maternity bras usually include extra rows of hooks so you can adjust the size as your body changes.
  • Cotton bras are more comfortable than synthetic ones because cotton allows the skin to breathe.

Nighttime support

  • A maternity bra or a pregnancy sleep bra (a soft, nonrestrictive cotton bra) may give your breasts added support and make you more comfortable during the night.

Breast pads

  • Wear disposable or washable breast pads if you are leaking colostrum.
  • Allow your breasts to air-dry a few times each day and after showering.

Bathing

  • Avoid soap on your nipples and areolas. Washing with soap tends to dry out the skin in this area.
  • Try using just warm water.

When to talk to your health care provider
If you do not have any breast changes during pregnancy, other factors may be involved. If you had breast surgery (for instance, a biopsy or implants) before becoming pregnant, talk to your health care provider or a breastfeeding specialist.

June 2009

Congestion and nosebleeds

During pregnancy, you may have a runny or stuffy nose or occasional nosebleeds. These symptoms often begin toward the end of the first trimester and may continue until after delivery.

Causes of congestion and nosebleeds

  • During pregnancy, your body goes through hormonal changes, and your blood supply increases. These changes may cause the membranes in your nose to swell, dry out or bleed more easily.
  • These changes may cause you to have a constant stuffy or runny nose, even if you have no cold symptoms.
  • You may have occasional nosebleeds, particularly during the winter months.
  • These symptoms often begin towards the end of the first trimester and may continue until after delivery.

What you can do
To help relieve congestion and dryness:

  • Use a humidifier. This will help to moisten the air in your home. Keep a humidifier in the bedroom to help ease congestion that keeps you awake at night. Be sure to clean the humidifier often.
  • Drink plenty of fluids. This will help keep your nasal passages moist.
  • Use steam. Take a warm shower before bedtime. It may help ease congestion that keeps you awake at night.
  • Use saline drops. They help moisten your nasal passages. You can find these at the drug store. However, don't use medicated nose drops, sprays or decongestants without first checking with your health care provider.
  • Blow your nose gently. Blowing your nose hard or often can aggravate the membranes and lead to more runniness or nosebleeds.
  • Use a warm, wet washcloth. Apply it to your cheeks, eyes and nose to help reduce congestion.
  • Elevate your head. Use an extra pillow when you sleep to prevent mucus from blocking your throat.

To stop a nosebleed:

  • Remain seated and keep your head up. Lying down or tilting your head can cause you to swallow blood and become nauseated.
  • Apply pressure. Hold the nostril closed for at least 4 minutes.
  • Use ice or a cold pack. This helps narrow the blood vessels and stop the bleeding.

When to talk to your health care provider
Nosebleeds and congestion are rarely signs of any serious problems. Usually, the congestion, runny nose and nosebleeds that occur during pregnancy clear up shortly after delivery.

Talk to your health care provider if you have nosebleeds often or if the bleeding doesn't stop after applying pressure and ice. If the congestion is not eased by any of the suggestions above or if congestion keeps you from getting a good night's rest, talk to your health care provider about whether it is safe to take an over-the-counter decongestant.

If you have a stuffy or runny nose as well as signs of a cold or flu, talk to your health care provider before taking any type of over-the-counter cold remedies. The signs of cold or flu are sneezing, coughing, a sore throat, fever or minor aches and pains.

Last reviewed June 2009

Fatigue

Fatigue is when you feel very tired or exhausted. Most women are more tired than usual during pregnancy, especially during early and late pregnancy. At these times, your body is producing new hormones and making a lot of changes to prepare for the hard work ahead.

Causes of fatigue
During early pregnancy, your body makes more of a hormone called progesterone. This can make you feel sluggish and sleepy. Your body is also producing more blood to carry nutrients to the baby. This causes more work for your heart and other organs. Your body also changes the way it processes foods and nutrients. All of these changes are stressful for your body and may lead to fatigue.

Physical and psychological changes during pregnancy can also cause mental and emotional stress. This stress can add to your feelings of fatigue.

During later pregnancy, the additional weight of the baby further taxes your body's strength. Several changes may occur later in pregnancy that make you feel tired:

Anemia
Fatigue can be a symptom of anemia, particularly iron-deficiency anemia. Iron-deficiency anemia affects about half of all pregnant women.

Your body needs iron to make hemoglobin, the substance in red blood cells that enables them to carry oxygen to your tissues and to your baby. Your need for iron increases during pregnancy because of the needs of the baby, the increase in blood produced by your body, and the blood loss that occurs during delivery.

Other signs of anemia include:

What you can do
The following tips may help you avoid excessive fatigue during pregnancy:

Take naps and breaks.

  • Rest when you can during the day, during your lunch hour or before dinner.
  • At work, take frequent breaks to pace yourself and renew your energy.

Go to bed early.

  • You may need to go to bed earlier than usual, especially if you find yourself waking up several times during the night.
  • Go to bed when you feel tired. Don't push yourself to stay awake until your usual bedtime.

Avoid getting up during the night.

  • Drink adequate fluids earlier in the day.
  • Avoid drinking anything for 2 or 3 hours before bedtime so that you won't have to get up often during the night to urinate.
  • If you often have heartburn, be sure to eat your last meal of the day several hours before lying down or going to sleep.
  • Gently stretch your leg muscles before bedtime. This may help you avoid nighttime leg cramps.

Exercise.

  • Unless your health care provider has advised against it, try to exercise for 2 1/2 hours a week, which means at least 30 minutes per day on most days.
  • Even moderate exercise like walking can lift your spirits and increase your energy level.
  • Find out from your health care provider what exercises are safe for you and how long you can maintain your exercise program.

Drink plenty of fluids.

  • Lack of fluids can contribute to fatigue.
  • Be sure to drink enough fluids, but stop drinking at least 3 hours before you go to bed.

Cut back and relax.

  • Avoid stressful situations.
  • Cut back on social events and other activities that may tire you out. Instead, spend this time on things that you find soothing and relaxing.
  • Use relaxation techniques, such as deep breathing, when you feel that you need a break.

Ask for help.

  • Let your partner, children or friends help out around the house as much as possible.
  • If you are feeling overstressed, talk to friends and relatives who can help you feel better.
  • Talk to your health care provider about finding support groups and other resources.

Eat healthy foods.

  • Eat foods that have iron and protein.
  • Learn more about foods that contain iron and other important vitamins and minerals during pregnancy.
  • Take a prenatal vitamin. Your provider may also recommend taking an iron supplement.

When to talk to your health care provider
Some tiredness is normal during pregnancy, especially during the first and third trimesters. While the symptoms generally improve during the second trimester, some women feel tired throughout their pregnancy. Talk to your health care provider if you feel:

  • Sudden fatigue
  • Fatigue that doesn't go away with adequate rest
  • Severely fatigued a few weeks into your second trimester
  • Depressed or worried

You may experience pica, an appetite for non-food items like ice, dirt, clay or paper. Pica has been linked to iron deficiency. While these cravings can be common, it's not a good idea to eat dirt, clay or paper. Talk to your health care provider. He can check your blood count and perhaps prescribe an iron supplement.

June 2009

 

Frequent urination

During pregnancy, you may feel the need to urinate often, sometimes even when your bladder is almost empty. During later pregnancy, many women find that they need to urinate even more frequently. Many pregnant women leak some urine when coughing, laughing, sneezing or exercising. During pregnancy, it’s normal to need go to the bathroom often.

How the bladder works
The bladder is a balloon-shaped muscle that stores urine. Muscles under the bladder keep the urethra (the tube where urine leaves your body) closed and keep urine from leaking out.

The pressure of a full bladder signals your brain, giving you the “urge” to urinate. When you urinate, the muscles around the urethra relax and the bladder tightens to squeeze urine out.

Causes of frequent urination during pregnancy
Your need to go to the bathroom will change throughout the stages of pregnancy. Sometimes, you may feel the need to urinate more often. Other times, you’ll feel like you’re back to normal.

  • In the first weeks of pregnancy, your body produces a hormone called human chorionic gonadotropin (hCG), which can make you urinate more often.
  • Your body contains more fluid during pregnancy.
  • Your kidneys work harder throughout your pregnancy to flush waste products out of your body.
  • As the uterus grows and rises higher during the second trimester, some women find that they don't have to urinate as frequently as before.
  • Towards the end of pregnancy, the baby moves lower to prepare for delivery. This increases the pressure on your bladder, causing even more frequent urination.
  • The added pressure may wake you up several times each night to urinate.
  • It may also force some urine to leak out, particularly if the muscles around the urethra are not very strong.

After birth
For the first few days after delivery, you may urinate even more often as your body gets rid of the extra fluid of pregnancy. But after a few days, your need to urinate should return to what it was before you became pregnant.

What you can do
Here are some tips for dealing with frequent urination or leaking during pregnancy:

Stay away from caffeinated drinks.

  • Caffeine can make you urinate more frequently.
  • Avoid beverages like coffee, tea, colas and other caffeinated drinks.

Do Kegel exercises.

  • These simple exercises can help stop urine leaks by strengthening the muscles that keep the urethra (the tube where urine leaves your body) closed. They may even help prepare these muscles for labor and delivery.
  • Do these exercises by squeezing the muscles you use to stop the flow of urine and holding them for 10 seconds.
  • Do this 10-20 times in a row at least three times a day.

Avoid drinking fluids right before bedtime.

  • Cut down on nighttime visits to the bathroom by drinking fluids earlier in the day.
  • Reduce how much you drink in the early evenings and nighttime.
  • But be sure to drink adequate amounts of water and juice during the day to make sure that you are not robbing your body of vital fluids.

Empty your bladder completely.

  • To help prevent leaks, be sure that your bladder doesn't get too full.
  • Try not to “hold it” when you feel the urge to urinate. This may mean more trips to the bathroom.
  • When you urinate, try leaning forward a bit in order to completely empty your bladder. Always empty your bladder before exercising.

Wear a sanitary pad or panty shield.

  • A minipad or panty shield can catch unexpected leaks caused by coughing or sneezing.

When to call your provider
Talk to your health care provider right away if you have any of these warning signs:

  • Pain or burning when you urinate
  • The urge to urinate again immediately after you empty your bladder.
  • Fever
  • Blood in the urine

These signs could mean you have a urinary tract infection (UTI), the most common infection in pregnant women. If untreated, a UTI can lead to more serious infection or preterm labor.

August 2009

Gas

Most pregnant women suffer from bloating and increased gas in the belly at some point during pregnancy. Gas can cause abdominal pain or discomfort.

During pregnancy, hormones relax the muscles in your digestive tract. This slows down your digestion and can cause gas to build up. Gas leads to bloating, burping, passing gas, discomfort, and pain in the belly—especially after a big meal.

Foods that can cause gas
Some people naturally produce more gas than others. Certain foods can make gas worse, but these vary from person to person. Some of these foods include:

  • Some starches (such as pasta and potatoes)
  • Some fiber-rich foods (such as oat bran and beans)
  • Foods that contain certain sugars (such as cabbage and cauliflower)
  • Dairy products (such as milk and cheese), especially for women who have trouble digesting these foods

What you can do

Reduce the amount of air you swallow.

  • Eat several small meals throughout the day instead of a few large meals.
  • Don't eat in a hurry. Take your time, chew your food thoroughly, and don't talk while eating.
  • Avoid drinking from a bottle or straw.
  • Cut down on carbonated beverages. Don't gulp while drinking.
  • Avoid chewing gum or sucking on hard candy.

Identify foods that bother you.

  • Keep a food diary to help you find the foods that cause problems.
  • Cut back on these foods, if possible, while being sure to eat healthy foods.
  • Cut back on fried and fatty foods, which can add to bloating.

Ask before taking over-the-counter remedies.

  • Talk to your health care provider before taking over-the-counter medicines for your gas and bloating symptoms.
  • Some medicines are unsafe during pregnancy and may harm you and your baby.

When to talk to your health care provider
If changes in the food you eat and your habits don't help, talk to your health care provider. Contact your health care provider immediately if:

  • Gas feels like labor contractions (coming and going regularly, every 5-10 minutes).
  • Gas pain is accompanied by blood in your stool, severe diarrhea, or increased nausea and vomiting.

August 2009

 

Gum and teeth change

During pregnancy, your gums are more likely to become inflamed or infected. Most pregnant women have some bleeding of their gums, especially while brushing or flossing their teeth. Inflamed gums are called "gingivitis." Infected gums are called "periodontal disease." You may also notice that your mouth produces more saliva during pregnancy. Your gums and teeth may change during pregnancy because of:

  • Hormonal changes
  • Increased blood flow throughout your body that can cause swelling, sensitivity and tenderness in your gums

What you can do
It's important to keep you gums and teeth healthy during pregnancy.

Keep teeth and gums clean.

  • If possible, brush after every meal for at least 5 minutes at a time.
  • Floss daily. If possible, floss after every meal.

Be gentle with your teeth and gums.

  • Use a soft-bristled brush and brush gently.
  • If you have a lot of sensitivity, try using toothpaste designed for sensitive gums.
  • If your gums hurt after brushing, apply ice to soothe the pain.

Cut down on sweets.

  • Candy, cookies, cake, soft drinks and other sweets can contribute to gum disease and tooth decay.
  • Instead, have fresh fruit or make other healthy choices to satisfy your sweet tooth.

Get regular dental care.

  • If left unchecked, some conditions, like gingivitis, may lead to more serious gum disease.
  • Be sure to have a dental checkup early in pregnancy to help your mouth remain healthy.
  • You may even want to see your dentist more often than usual.

Don't put off dental work until after delivery.

  • Decaying teeth can cause infection that could harm your baby.
  • Always be sure to tell your dentist that you're pregnant and how far along you are.

When to talk to your dentist
Schedule a dental appointment immediately if:

  • Your gums bleed a lot
  • Your gums are painful
  • You have bad breath that doesn't go away
  • You lose a tooth
  • You have a lump or growth in your mouth
  • You have pain in a tooth

For more information
Download a brochure from the National Maternal and Child Oral Health Resource Center.

Hair changes

During pregnancy, you may notice that the hair on your head is thicker than usual. After pregnancy, you may find that you'll lose a lot of hair a few weeks or months after delivery. These changes are normal. Hair growth generally returns to its regular growth cycle within six months after delivery.

Before pregnancy
When you're not pregnant, the hairs on your head grow in a regular cycle. Each hair:

  • Usually grows about 1/2 inch per month for anywhere from 2 to 6 years
  • Then goes into a "resting" phase for 2 or 3 months, in which the hair stops growing
  • Then gradually falls out, usually when you're brushing or washing your hair
  • The growth cycle then starts again. At any one time, about 10 percent of the hair on your scalp is in a resting phase, and about 90 percent is growing.

During pregnancy
The hair on your head may appear thicker while pregnant. This is because higher hormone levels prevent normal hair loss. During pregnancy:

  • Your hair tends to stay in the resting phase longer than usual.
  • Most hairs are in the resting phase at any one time.
  • Fewer hairs fall out each day, causing your hair to seem thicker and fuller.

After pregnancy
Once you have your baby, your body will try to return to its prepregnancy shape. This includes your hair. After delivery:

  • The resting phase shortens.
  • Normal hair loss that was delayed by pregnancy tends to take place all at one time.
  • This may cause your hair to seem thinner than usual.
  • Hair thinning is usually not serious enough to cause bald spots or permanent hair loss.
  • While more hairs fall out, you start to grow new hair.
  • Your normal hair growth cycle begins to return.

Other hair growth
Some women also develop more hair on their chin, upper lip, cheeks, arms and legs during pregnancy. You also may notice new hairs (sometimes even just one or two) on your breasts, belly and back.

Hair growth on the face, arms and legs during pregnancy is normal. Pregnancy hormones and increased cortisone cause this type of hair growth during pregnancy. This growth usually lessens within about 6 months after pregnancy. Your hair growth will then return to its regular growth cycle.

What you can do
You can do several things to have a healthier head of hair during pregnancy and after delivery:

  • Eat plenty of fruits and vegetables. These foods may provide protection for the hair shafts and encourage hair growth.
  • Be gentle with your hair when it is fragile and wet. Avoid fine-tooth combs.
  • Avoid using blow dryers and other heated hair instruments. If you must use a hair dryer, use the cooler settings.
  • Avoid pigtails, cornrows, tight braids and tight hair rollers. They can pull and stress your hair.

To get rid of unwanted hair growth:

  • Tweeze, wax or shave, which are all safe during pregnancy.
  • Avoid using bleaches or depilatories during pregnancy. They can be absorbed into the skin.
  • Permanent hair-removal techniques (such as electrolysis) are thought to be safe during pregnancy. But they can be painful or uncomfortable.

When to talk to your health care provider
If you have a lot of hair loss or lose quarter-size patches of hair, you may not be getting enough vitamins or minerals. Losing a lot of hair may also be a sign of a medical problem unrelated to your pregnancy (such as a skin disease or a thyroid disorder). Talk to your health care provider if you feel that your hair loss is unusual or excessive.

June 2009

Headaches

Headaches are common during pregnancy, especially during the first and third trimesters. They rarely signal a serious problem.

Causes of headaches during pregnancy
The cause of headaches is uncertain. In the first few months of pregnancy, they may be caused by normal changes in your hormone levels and an increase in blood volume and circulation.

In the second trimester, pregnancy-related headaches may disappear as your body becomes used to the hormonal changes. Towards the end of pregnancy, headaches tend to be related more to posture and tension from carrying extra weight.

During the second and third trimesters, headaches may also be caused by a serious condition called preeclampsia (high blood pressure during pregnancy). Preeclampsia requires immediate medical attention (see below).

Headaches and other pains
Some women often have tension headaches, which cause squeezing pain or a dull ache on both sides of the head or the back of the neck. The headaches may increase during pregnancy, especially if the woman experiences any of the following:

  • Stress
  • Fatigue
  • Caffeine withdrawal (especially if she suddenly stops or cuts down on coffee drinking or other sources of caffeine when she learns she is pregnant)
  • Lack of sleep
  • Dehydration (lack of fluids)
  • Hunger or low blood sugar

Migraines
Some women may have migraine headaches for the first time in early pregnancy. These headaches cause severe, throbbing pains on one side of the head. The woman may also have nausea or vomiting. But many women who are prone to migraines may notice that they improve during pregnancy. Some migraine sufferers may notice no change during pregnancy or may find that their headaches become more frequent and intense.

What you can do
Before taking any medications or herbal remedies, always talk to your health care provider. If you regularly suffer from migraines, ask your health care provider before taking the medications you normally used before becoming pregnant. The following tips may safely help relieve or prevent headaches during pregnancy:

Use warm or cold compresses.

  • To soothe a headache in the sinus area, apply warm compresses to the front and sides of your face and around your nose, eyes and temples.
  • To relieve a tension headache, apply a cold compress to the back of your neck

Reduce stress.

  • Avoid placing yourself in stressful situations.
  • Relaxation exercises may help. For instance, try deep breathing or simply closing your eyes and imagining a peaceful scene.

Rest and exercise.

  • Resting in a dark, quiet room can soothe headaches.
  • Getting enough sleep and exercise can also be helpful.
  • Always be sure to find out from your health care provider which exercises are safe for you, and how long you can maintain your exercise program.

Eat well-balanced meals.

  • Eat smaller, more frequent meals throughout the day.
  • This can help keep your blood sugar from getting too low.

Take care of your body.

  • Maintain good posture, especially during the third trimester.
  • Get a massage. Massaging your temples, shoulders and neck can help reduce the pain of headaches.

Avoid headache triggers.

  • Different kinds of food or stresses can trigger headaches. For instance, triggers of migraine headaches include chocolate, aged cheese, peanuts and preserved meats.
  • Keep a diary, and review the kinds of foods and activities that tend to trigger tension or migraine headaches.

When to talk to your health care provider
While most headaches during pregnancy are harmless, some can be a sign of a more serious problem. If you have a migraine for the first time during pregnancy, or if you have a headache that feels unlike any you've experienced before, call your health care provider to make sure it is not a sign of more serious problems. Call your health care provider right away if your headache:

  • Is sudden and explosive or includes a violent pain that awakens you from sleep
  • Is accompanied by fever and stiff neck
  • Becomes increasingly worse, and you have vision changes, slurred speech, drowsiness, numbness or a change in sensation or alertness
  • Occurs after falling or hitting your head
  • Is accompanied by nasal congestion, pain and pressure underneath your eyes, or dental pain (these may be signs of sinus infection)

Preclampsia
In the second or third trimester, headaches can be a sign of preeclampsia, a serious condition that includes high blood pressure. Contact your health care provider immediately if your headache:

August 2009

Heartburn and indigestion

Many women have heartburn for the first time during pregnancy, particularly during the second and third trimesters. Although this is not usually a sign of a serious problem, it can be uncomfortable or painful. Gastroesophageal reflux is often called "acid reflux" or "heartburn." But this condition has nothing to do with the heart!

Indigestion is also common during pregnancy and can occur with heartburn. Also known as "dyspepsia," indigestion is just another name for an upset stomach. You'll know you have indigestion if you feel very full, bloated or gassy.

Causes of heartburn and indigestion during pregnancy
Heartburn occurs when digested food from your stomach, which contains acid, is pushed up toward your esophagus (the pipe between your mouth and your stomach). This causes a burning sensation behind your breastbone or a burning sensation that starts in your stomach and seems to rise up. You may also have a sour taste in your mouth or a feeling that vomit is rising in your throat.

  • Normally, food moves down the esophagus between your mouth and your stomach.
  • When you're not eating, a circular valve around the bottom of your esophagus closes off the connection between your esophagus and your stomach.
  • This valve keeps the acids in your stomach from rising up.
  • When you swallow, the valve relaxes to allow food and liquid to flow through.
  • If the valve relaxes when you're not eating, the acids from your stomach can flow back up into your esophagus, irritating it and causing a burning sensation.

Several things can cause heartburn and indigestion, such as:

  • Greasy or fatty foods
  • Chocolate, coffee and other drinks containing caffeine
  • Onions, garlic or spicy foods
  • Certain medications
  • Eating a very large meal
  • Eating too quickly
  • Lying down after eating

Pregnancy hormones
During pregnancy, hormones relax the muscles in your digestive tract, including the valve in the esophagus. This allows stomach acids to more easily seep back up the esophagus, especially when you're lying down. Heartburn can be worse in the second and third trimesters, when your growing uterus presses on your stomach. This sometimes pushes food back up into the esophagus.

Pregnancy hormones also slow down:

  • The muscles that push food from your esophagus into your stomach
  • The muscles that contract to digest food in your stomach, which slows down your digestion
  • These changes can also lead to indigestion, which can make you feel very full, bloated or gassy.

What you can do
Follow these tips to prevent heartburn:

Eat smaller meals.

  • Eat five or six small meals a day instead of eating three large meals.
  • This can help your body digest food better.

Drink less while eating.

  • Avoid drinking large amounts of fluids with your meals.
  • Drink fluids between meals instead.

Avoid foods that trigger heartburn.

  • Avoid spicy, greasy or fatty foods, chocolate and caffeine.
  • These kinds of food can cause heartburn.

Avoid bending or lying down right after eating.

  • Sit up, do light housework, or take a walk until your body has had a chance to digest.
  • Be sure to eat your last meal of the day several hours before bedtime.
  • If you need to lie down, prop your upper body up with a few pillows.

Don't gain too much weight.

  • Gain a sensible amount of weight.
  • Stay within the guidelines your health care provider sets.
  • Excess pounds put extra pressure on your abdomen, increasing your chances of getting heartburn.

Wear comfortable clothes.

  • Tight clothing can increase the pressure on your stomach and abdomen.
  • Wear loose clothing to feel more comfortable.

Raise your head when you lie down.

  • Prop your head up a few inches with pillows.
  • If possible, keep the foot of your bed lower than the head of your bed.
  • If you need an antacid to relieve symptoms, talk to your health care provider to choose the right one for you.

When to talk to your health care provider
For most people, heartburn is temporary and mild. But severe heartburn can be the sign of a more serious problem. Talk to your health care provider if you have any of the following:

  • Heartburn that returns as soon as your antacid wears off
  • Heartburn that often wakes you up at night
  • Difficulty swallowing
  • Spitting up blood
  • Black stools
  • Weight loss

August 2009

Hemorrhoids

Many pregnant women get hemorrhoids (also called "piles") while pregnant, especially during the third trimester. Hemorrhoids are more common if the woman is constipated.

Causes of hemorrhoids during pregnancy
Hemorrhoids are varicose veins (swollen veins) that appear in the rectal area. They can sometimes protrude from the anus. They are often itchy or painful and can sometimes rupture and bleed.

Hemorrhoids occur when straining or pressure causes the veins in your rectum to swell and enlarge. Three common causes of hemorrhoids are:

  1. Straining during bowel movements
  2. The strain of excess weight
  3. The pressure of sitting or standing for long periods of time

During pregnancy:

  • Your growing uterus can increase the pressure on the veins in the lower body. This can lead to hemorrhoids.
  • Pregnancy hormones can also cause the walls of your veins to relax. This allows them to swell more easily.
  • Straining, especially during hard bowel movements, traps more blood in the swollen veins. This can make hemorrhoids very painful.
  • Straining can also cause hemorrhoids to protrude from the rectum.

If you have had hemorrhoids before pregnancy, you're more likely to get them again while pregnant. They may also develop or flare up with the straining of labor.

What you can do
You can help prevent hemorrhoids by making simple lifestyle changes that keep you from getting constipation:

Drink plenty of liquids.

  • Drink at least 8-10 glasses of water each day.
  • One to two glasses of fruit juices, such as prune juice, can help.

Eat foods high in fiber.

  • Eat raw fruits, vegetables, bran cereals and other sources of fiber.
  • If you are also suffering from increased gas, start eating foods that are high in fiber.
  • Wheat bran is a good fiber supplement. It causes less gas than other fiber-rich foods.

Exercise regularly.

  • With your health provider's OK, walking and engaging in other safe activities for at least 2 1/2 hours of aerobic exercise every week can help the digestive system do its work. This means that most pregnant women should try to get 30 minutes of aerobic exercise on most, if not all, days.
  • Always be sure to find out from your health care provider what exercises are safe for you and how long you can maintain your exercise program.

When you gotta go, you gotta go.

  • Always go to the bathroom as soon as you feel the urge.
  • When you delay, it becomes harder to pass stool.

Don't gain too much weight.

  • Gain a sensible amount of weight.
  • Stay within the guidelines your health care provider sets.
  • Excess pounds put extra pressure on your abdomen. This increases your chances of getting hemorrhoids.

Avoid long periods of standing or sitting.

  • If you must sit for long periods, get up and move around for a few minutes every hour or so.
  • When lying down, lie on your left side to help take the pressure off.

Most hemorrhoids improve on their own. But you can do several things to help you relieve the pain, swelling and itching of hemorrhoids:

  • Soak your rectal area in warm water for 10 to 20 minutes at a time for several times a day. At most drug stores, you can get a sitz bath that you can use for this. A sitz bath is a small basin that fits over the seat of the toilet.
  • Ask your health care provider about which over-the-counter hemorrhoid creams are safe to use.
  • Use unscented, white brands of toilet paper. Some women find it helpful to wipe the anal area with moist towelettes, wet toilet paper, or medicated pads instead of toilet paper.
  • Keep the anal area clean. Soap isn't necessary and may aggravate the problem. Be careful to gently dry the area after bathing, since moisture can cause irritation.
  • Apply ice packs or cold compresses for 10 minutes up to four times a day.
  • If a hemorrhoid begins to stick out, gently push it back into the rectal canal.

When to talk to your health care provider
Most hemorrhoids go away on their own, but some require a medical procedure. Talk to your health care provider if:

  • You don't get relief using the suggestions above
  • You notice bleeding

August 2009

Leg cramps

During the second and third trimesters, you may have painful leg cramps, particularly at night or while sleeping. You may also have a jumpy feeling in your legs. Leg cramps tend to occur more often during the last months of pregnancy.

Causes of leg cramps during pregnancy
Leg cramps are a sudden tightening of muscles, which can cause intense pain. The muscles may tighten for a variety of reasons, such as:

  • Lack of fluids
  • Injury
  • Muscle strain
  • Staying in the same position for a long period of time
  • Blood circulation problems or pressure on the nerves in the spine

The reasons for increased leg cramps during pregnancy aren't clear. They may be caused by:

  • Changes in blood circulation during pregnancy
  • The stress on your leg muscles of carrying the extra weight of pregnancy
  • The pressure of the growing baby on the nerves and blood vessels that go to your legs

Experts once thought that most leg cramps were caused by not eating enough healthy foods with calcium. They no longer believe that this is true. (But, calcium is important to your baby's development and it helps keep your own bones strong and healthy. Be sure you are eating enough dairy products and other foods that contain calcium during pregnancy.)

What you can do
Here are some tips to prevent or relieve leg cramps:

Stretch

  • Stretching your legs (especially your calves) before going to bed can help reduce your chances of getting leg cramps.
  • When you feel a cramp in your leg, straighten your leg—heel first—and wiggle your toes.
  • Avoid pointing your toes when stretching or exercising.

Don't stay still

  • Avoid standing or sitting in one position for long periods of time.
  • Avoid sitting in a position that may restrict blood flow (such as sitting with your legs crossed for long periods of time).

Exercise

  • With your provider's OK, regular exercise, such as a daily walk, can help prevent leg cramps.
  • If you're able to stand, walking for a few minutes when you have a leg cramp can help ease the pain and relax the muscle.

Drink plenty of fluids

  • Avoid getting dehydrated.
  • Be sure to drink plenty of water during the day.

Massage your legs and apply heat

  • When you have a leg cramp, relax the muscle through gentle massage, or heat the muscle with a warm towel or hot water bottle.
  • A warm bath before bedtime may also help to relax your muscles and prevent leg cramps.

When to talk to your health care provider
Leg cramps usually go away on their own without medical treatment. But they can be a sign of a more serious problem. Talk to your health care provider right away if:

  • The pain is frequent and severe
  • You notice any redness, warmth, swelling or tenderness in your leg

September 2009

Morning sickness

Morning sickness (also called nausea and vomiting of pregnancy, or NVP) is feeling sick to your stomach (also called nausea) and vomiting that happens in the first few months of pregnancy. Even though it's called morning sickness, it can last all day and happen any time of day.

At least 7 in 10 women have morning sickness during the first trimester (first 3 months or about 12 weeks of pregnancy). It usually starts at about 6 weeks of pregnancy and is at its worst at about 9 weeks. Most women start to feel better in their second trimester. But some may have morning sickness throughout pregnancy.

Mild morning sickness doesn’t harm you or your baby. But if morning sickness becomes severe (called hyperemesis gravidarum), it can lead to weight loss and dehydration (not having enough water in your body). These problems can be harmful during pregnancy. If you have severe morning sickness, you may need to stay in the hospital for treatment.

What causes morning sickness?

No one knows for sure what causes morning sickness. An increase in pregnancy hormones, like human chorionic gonadotropin (also called HCG), or low blood sugar early in pregnancy may cause morning sickness. Being stressed or overly tired, eating certain foods and traveling (if you’re likely to have motion sickness) may make the morning sickness worse.

What can you do relieve or prevent morning sickness?

Here are some things you can do to help you feel better and may even prevent morning sickness:

  • Keep snacks by your bed. Eat a few crackers before you get up in the morning to help settle your stomach.
  • Eat five or six small meals each day instead of three larger meals.
  • Eat foods that are low in fat and easy to digest, like cereal, rice and bananas. Don’t eat spicy or fatty foods.
  • Eat healthy snacks between meals. This helps keep your stomach from being empty and helps prevent feeling sick to your stomach. Try snacks that are high in protein, like milk or yogurt.
  • Drink plenty of fluids, especially water.
  • Avoid smells that upset your stomach.
  • Take your prenatal vitamin at night or with a snack. Sometimes vitamins can upset your stomach.

Talk to your health care provider before trying any of these methods to relieve or prevent morning sickness:

  • Acupressure wristbands. Wearing these wristbands may help with morning sickness and other kinds of nausea. You can buy them at most drug stores.
  • Acupuncture. This treatment involves inserting hair-thin needles into your skin. If you’re thinking about acupuncture to help with morning sickness, tell your provider and find an acupuncturist who is trained to work with pregnant women.
  • Ginger. Ginger ale, tea or candies may help relieve morning sickness.

When should you call your health care provider about morning sickness?

For most women, morning sickness is mild and goes away over time. But call your health care provider if:

  • Your morning sickness continues into your 4th month of pregnancy.
  • You lose more than 2 pounds.
  • Your vomit is brown in color or has blood in it. Call your provider right away in these cases.
  • You vomit more than 3 times a day and can’t keep food or fluids down.
  • Your heart beats faster than usual
  • You’re tired or confused
  • You’re making much less urine than usual, or no urine at all

What is severe morning sickness?

About 2 in 100 women may have a severe kind morning sickness called hyperemesis gravidarum, which means severe vomiting during pregnancy. Women with this condition can’t keep any food or fluid in their stomach. They may lose weight or become dehydrated. This condition can begin early in pregnancy and last throughout pregnancy.

You may be more likely than other women to have severe morning sickness if you:

Signs of severe morning sickness include:

  • Vomiting more than 3 to 4 times a day
  • Vomiting that makes you dizzy, lightheaded or dehydrated. Signs of dehydration include feeling thirsty, having a dry mouth, having a fast heart beat or making little to no urine.
  • Losing more than 10 pounds in pregnancy

If you have severe morning sickness, your provider may prescribe a medicine to help relieve your nausea. It comes as a tablet that you take every day as long as you have severe morning sickness. Some women may need treatment in a hospital with intravenous fluids. These are fluids that are given through a needle into a vein.

Last reviewed July 2013

 

Shortness of breath

Most pregnant women feel short of breath both in early and late pregnancy. This is generally harmless and does not affect the amount of oxygen your baby gets.

Causes of shortness of breath during pregnancy

Early pregnancy

  • In the first few weeks of pregnancy, a normal increase in the hormone progesterone causes you to breathe more often.
  • This can look and feel like shortness of breath.
  • This hormone expands your lung capacity, allowing your blood to carry large quantities of oxygen to your baby.

Later pregnancy

  • As your pregnancy continues and the baby gets bigger, shortness of breath occurs as your growing uterus takes up more room in your belly.
  • Your uterus pushes on and shifts other organs in your body.
    Around the 31st to 34th week of pregnancy, the uterus begins to press on the diaphragm (the flat muscle that moves up and down when you breathe).
  • These changes may make it hard for your lungs to fully expand.
  • This may cause more shallow breathing, and you may feel short of breath.

End of pregnancy

  • During the last few weeks of pregnancy, you may have less shortness of breath when your baby settles deeper into the pelvis to prepare for birth.
  • With the baby in this position, some of the pressure on the lungs and diaphragm decrease.

What you can do
These tips may help you to breathe easier:

  • Sit or stand up straight. These positions give your lungs more room to expand.
  • Slow down. When you move more slowly, you lessen the work of your heart and lungs.
  • Lift your arms over your head. By taking pressure off your rib cage, you can breathe in more air.
  • Sleep propped up. To put less pressure on your lungs, prop up your upper body with pillows.

When to talk to your health care rovider
It's normal to feel a mild breathlessness during pregnancy. Talk to your health care provider immediately if your breathlessness becomes severe or comes on very suddenly. Also, call your health care provider right away if you have any of these symptoms:

  • A rapid pulse
  • Heart palpitations (your heart beats fast and strongly)
  • Feeling dizzy or faint
  • Chest pain
  • Blueness around the lips, fingers or toes
  • A cough that doesn't go away
  • Coughing up blood
  • Fever or chills
  • Worsening asthma

Any illness that affects breathing can be more serious during pregnancy. If you have asthma, be sure to talk to your health care provider about how to best manage this condition during pregnancy. Your asthma may stay the same, worsen or improve during pregnancy. Women with moderate to severe asthma are at increased risk of an asthma attack during the third trimester of pregnancy and during labor and delivery.

August 2009

Skin changes

Some women may find that their skin has changed during pregnancy. Many of these changes are common and can be different from woman to woman.

Causes of skin changes during pregnancy
Changes in hormone levels during pregnancy can produce a wide range of skin changes, from stretch marks to acne to darkening of the skin. Most of these changes disappear shortly after delivery.

Types of Skin Changes

Acne

  • During early pregnancy, some women develop acne, especially those who were prone to breakouts during menstrual periods before pregnancy.
  • On the other hand, some women find that acne improves during pregnancy.

*See important information about Accutane below.

Bluish or blotchy legs

  • For some women, especially those who live in cold climates, increased hormones can cause temporary discoloration or blotchy skin on the legs.
  • This usually disappears after delivery.

Chloasma ("mask of pregnancy" or melasma)

  • Some women have a brownish darkening of the facial skin.
  • This change is called the "mask of pregnancy." It is more common in women with dark hair and pale skin.
  • The woman usually has brownish, uneven marks on the forehead, temples and middle of her face.
  • Sometimes the marks appear around the eyes or over the nose.
  • The darkened areas may get even darker when exposed to sunlight.
  • These marks usually fade completely after delivery.

"Glowing" skin

  • Blood flow increases during pregnancy, including in the tiny vessels just beneath the surface of your skin.
  • Pregnancy hormones cause skin glands to release oil. This may leave your face shiny.
  • The result of these two factors may be a healthy "glow."

Itchiness

  • Many pregnant women have itchy skin, particularly around the belly and breasts during the second and third trimesters.
  • This happens as the skin stretches to adapt to your body's growth.

Linea nigra (dark line on the belly)

  • For many women, extra pigment (coloring) in the skin causes a dark line to appear, running from the navel to the pubic area.
  • This line fades after delivery.

Nails

  • For some women, pregnancy hormones may cause changes in fingernails and toenails.
  • These changes include faster nail growth than usual or nails becoming brittle or soft.

Puffiness

  • During the third trimester, your eyelids and face may become puffy, usually in the morning.
  • This is because of increased blood circulation. This condition is harmless.
  • But if you have puffiness along with a sudden weight increase, contact your health care provider to rule out other potential problems.

Rashes

  • Many women sweat more during pregnancy because hormones affect the sweat glands. This can increase the chances of getting heat rashes.
  • Late in pregnancy, some women also develop harmless but itchy red bumps on the belly.
  • These can spread to the buttocks, arms and legs, causing discomfort.

Red or itchy palms

  • Increases in the hormone estrogen may cause your palms to become red and itchy.
  • For some women, this may also affect the soles of their feet.
  • Like most skin changes that occur during pregnancy, the redness usually fades after delivery.

Skin tags

  • Skin tags are small, soft, flesh-colored growths or flaps that protrude from your skin.
  • They usually form on the neck, breasts or armpits.
  • They are most likely caused by hormonal changes.
  • Skin tags do not go away on their own after delivery. A health care provider can easily remove them.

Stretch marks

  • As the breasts and abdomen grow, most women develop stretch marks across the belly and breasts.
  • These marks are small, depressed streaks of differently textured skin. They can be pink, reddish-brown or dark brown, depending on the woman's skin color.
  • Some women also get them on their buttocks, thighs, hips or breasts.
  • These marks are caused by tiny tears in the tissue that lies just below your skin and helps the skin stretch.
  • There is no way to prevent stretch marks during pregnancy. They usually fade and become less noticeable after delivery.
  • You may see creams to treat stretch marks in the drug store. It isn't clear whether these creams work.

Spider veins

  • Some pregnant women have spider veins on the face, neck, upper chest or arms.
  • These small, red spots have lines branching out from them.
  • Spider veins are tiny blood vessels that appear because of increased blood circulation. Hormonal changes may cause them.
  • These marks disappear or fade after delivery.

Skin darkening

  • In most pregnant women, hormonal changes cause darkening of skin that is already darker than the rest of the woman's skin.
  • This darkening may be most obvious in freckles, moles, areolas (colored rings around the breast nipples), nipples, labia (the genital tissue outside of the vagina) and the inner thighs.
  • Some of this darkening may fade after delivery. But these areas are likely to remain darker than they were before pregnancy.

What you can do
Many skin changes during pregnancy are unavoidable and most disappear on their own after delivery. These tips may help reduce or treat common skin problems that occur during pregnancy:

Skin cleansing

  • Good skin cleansing is the best way to avoid or treat acne breakouts.
  • Wash your face with a mild cleanser two or three times a day.
  • Don't wash too often or your skin may become dry, which can aggravate skin changes.

Sun protection

  • Your skin is more sensitive during pregnancy. Good sun protection is very important at this time.
  • Sunlight can darken pigment changes in your skin and increase your chances of getting "mask of pregnancy."
  • Use a good sun block, cover up, and wear a hat when outside.
  • Avoid spending time outdoors when the sun is strongest (between 10 a.m. and 2 p.m.).

Make-up

  • Cover-up and foundation can help hide dark streaks or spots on the skin.
  • Avoid makeup that contains mercury. Look at the label to see if the makeup contains mercury.

Stretch marks

  • You won't be able to avoid stretch marks entirely.
  • It will help if you gain only the recommended amount of weight for your size (usually 25 to 35 pounds), and do so slowly.

Moisturizers

  • Moisturize your belly and your breasts to reduce itchiness and dry skin.
  • To avoid skin irritation, use unscented moisturizer.
  • Use mild soap when washing.
  • Avoid hot showers or baths. They can dry the skin.

Excessive heat

  • Heat can intensify itchiness and rashes.
  • When you go out in warm weather, wear loose-fitting, cotton clothing.

IMPORTANT: Do not take any acne medications or over-the-counter treatments without checking with your health care provider. Some of these are not safe for pregnant women to use.

  • Accutane (also called isotretinoin, Amnesteem and Claravis) is a prescription medication used to treat severe acne.
  • It is a member of a family of drugs called retinoids. Accutane and other retinoids can cause very serious birth defects.

When to talk to your health care provider
Most skin changes during pregnancy are harmless and painless. A few conditions might require medical attention:

Severe itchiness, ICP

  • Severe itchiness, particularly in the third trimester, can be a sign of intrahepatic cholestasis of pregnancy (ICP).
  • This is a liver problem that affects a small number of pregnant women.
  • Symptoms include severe itchiness all over the skin and sometimes nausea, vomiting, fatigue, yellowing of the skin and loss of appetite.
  • ICP does not harm a woman's health, but it can hurt the baby.
  • Women who have ICP are more likely to have stillbirths or to deliver prematurely. Premature babies are at increased risk of health problems and lasting disabilities.
  • ICP usually goes away on its own after delivery.
  • Talk to your health care provider right away if you feel that you might have this condition.

Skin darkening with other symptoms

  • Certain types of skin darkening can be a sign of a serious problem.
  • Let your health care provider know if changes in skin color are accompanied by pain, tenderness, redness or bleeding, or if you notice any changes in the color, shape or size of a mole.

Puffiness of the eyelids

  • Some puffiness of the eyelids is normal during the third trimester.
  • Contact your health care provider if you suddenly gain 5 pounds or more. This could mean that you are retaining too much fluid and have high blood pressure.
  • Always talk to your health care provider before using any medicated creams or ointments to treat skin problems. Some are unsafe during pregnancy.

August 2009

 

Sleeping problems

Almost all pregnant women have sleep problems of one sort or another at some point. These problems may include:

  • Trouble falling asleep
  • Sleep that isn't restful
  • Waking up often during the night
  • Trouble returning to sleep

Causes of sleep difficulties during pregnancy

Early pregnancy
A number of problems can contribute to your sleeplessness during pregnancy. During early pregnancy:

  • The same pregnancy hormone that causes fatigue during the day can also disrupt your sleep cycle at night.
  • You may have trouble finding a comfortable position for sleeping.
  • You may find yourself waking up several times throughout the night to urinate.

Later pregnancy
As your pregnancy continues, a wide range of problems may disrupt your sleep.

  • As the size of your abdomen increases, you may have trouble finding a comfortable position.
  • Anxiety and stress can also contribute to sleeplessness, particularly as your due date approaches.

Other problems contributing to discomfort and insomnia include:

What you can do
Here are some tips to help you get enough rest:

Take a warm shower or bath at bedtime.

  • Remember that your sense of balance is off during your pregnancy. Be careful not to slip in a wet tub!
  • Never take a bath if you think your water has broken.

Reduce stress.

  • Avoid placing yourself in stressful situations.
  • Relaxation exercises, deep breathing or simply closing your eyes and imagining a peaceful scene may help.

Take naps.

  • Nap when possible during the day
  • This can help you avoid getting too tired, especially if you have a hard time getting restful sleep at night.

Avoid sleeping flat on your back.

  • This position puts the full weight of your uterus on your back and on the major vein that carries blood between your lower body and heart.
  • Sleeping on your back can increase your chances of getting backaches. It can also aggravate digestive problems, heartburn and hemorrhoids.
  • Try to get used to sleeping on your side, particularly on your left side. This position can improve your circulation and help reduce swelling in your feet.

Use pillows.

  • Tuck one pillow between your legs.
  • Use more pillows to support your back and abdomen.
  • If you suffer from shortness of breath or heartburn, use pillows to lift up your upper body.

Make your room comfortable.

  • Don't watch television or read in bed.
  • Use your bed only for sleeping.
  • Make sure the room is at a comfortable temperature.
  • Play some relaxing or natural sounds to help make you sleepy.

Go to bed earlier.

  • You may need to go to bed earlier than usual, especially if you find yourself waking up several times during the night.
  • Go to bed when you feel tired. Don't push yourself to stay awake until your usual bedtime.

Avoid getting up during the night.

  • Drink adequate fluids earlier in the day, but avoid drinking anything for the two or three hours before bedtime. This will reduce the number of times you need to get up to urinate.
  • If you are often troubled by heartburn, eat your last meal of the day several hours before lying down or going to sleep.
  • To prevent nighttime leg cramps, gently stretch your leg muscles before bedtime.

Exercise.

  • Unless your health care provider has advised against it, get at least 2 1/2 hours of aerobic exercise every week. This means that most pregnant women should try to get 30 minutes of aerobic exercise on most, if not all, days.
  • Even moderate exercise, like walking, can help you get a better night's sleep.
  • Always be sure to find out from your provider what exercises are safe for you and how long you can maintain your exercise program.

Do not take sleeping medications.

  • Always talk to your health care provider before taking any medications.

When to talk to your health care provider
Talk to your health care provider if your sleeplessness lasts a long time or continues to increase. If anxiety and stress are contributing to sleeplessness, your provider may be able to suggest support groups and other resources that may help.

August 2009

Swelling

It's normal for your body to produce and retain more fluid during pregnancy, particularly during the last few months. This can cause slight swelling (called edema), particularly in the legs, feet and ankles, but also in the hands and face. This swelling may be worse towards the end of the day or during hot summer months.

Causes of swelling during pregnancy
Extra fluid in your body helps prepare you for pregnancy and delivery. It allows your tissues to handle the growth of your baby. It also prepares your pelvic area for labor and delivery. Much of the weight you gain during pregnancy is from extra fluids. Your body usually gets rid of them in the days after delivery.

During late pregnancy, your growing uterus puts pressure on the veins to your legs and feet. This slows blood circulation and causes even more fluid to build up in your feet and ankles. Standing or sitting with your feet on the floor for long periods of time can increase the pressure on these veins.

What you can do
Some swelling, particularly in the feet and ankles, is normal during pregnancy. But if your swelling is severe, contact your health provider. Here are some tips for relieving and managing swelling that is normal:

Relieve the pressure.

  • Put your feet up on a footstool or hassock, or lie on your side.
  • This will relieve the pressure on the veins of your lower body and reduce the swelling.
  • Take breaks during the day where you can sit with your feet up.
  • While you sleep, raise your legs slightly with pillows.
  • Don't cross your legs when you sit.
  • Avoid standing or sitting with your feet on the floor for long periods of time.

Stay cool.

  • Heat can make the swelling worse.
  • Stay cool and try not to get overheated.

Improve your circulation.

  • Lying on your left side can help improve your circulation and reduce swelling.
  • After long periods of sitting, take a short walk.
  • Avoid tight clothes or jewelry that cut off the circulation at your wrists or ankles.
  • Leg massages and supportive tights or stockings can also help improve circulation.

Eat healthy foods.

  • It's important to eat healthy foods and get the right amount of protein. Too little protein can cause your body to retain fluid.
  • Salt increases water retention so try to limit or avoid very salty foods.
  • Drink plenty of water; 8 – 10 eight-ounce glasses of fluids per day. As strange as it may sound, drinking water actually helps reduce swelling by keeping you hydrated and flushing sodium (salt) from your body.

Be careful of medication.

  • Some medications, even those purchased over-the-counter, can cause serious harm to you and your baby during pregnancy.
  • Do not take any medication (such as "water pills") to reduce swelling without first talking to your health care provider.

When to talk to your health care provider
Mild swelling of the legs, hands and face is normal during pregnancy. But call your health care provider if you have severe or sudden swelling, particularly in your hands or in your face around the eyes. This could be a sign of a serious condition called preeclampsia (also called toxemia) that causes high blood pressure and fluid retention. Women with preeclampsia may experience any of the following symptoms:

Also call your health care provider if one leg is much more swollen than the other, especially if you also have pain or tenderness in your calf or thigh.

September 2009

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