Your pregnant body

• Your body goes through major changes during pregnancy.
• Weight gain, breast changes and aches and pains are common.
• There are ways to deal with common discomforts and changes.

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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:

• Difficulty sleeping
• The need to urinate often during the night
• Late-night cramps in your legs
• Heartburn

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:

• Shortness of breath
• Rapid or irregular heartbeat
• Weakness
• Pale skin
• Dizziness

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