Tiredness and Fatigue during Pregnancy

This article outlines the causes and remedies of tiredness and fatigue during pregnancy.

Tiredness is a common symptom during pregnancy and most women generally feel more tired than usual during this time. So, it is entirely normal to feel this way.

However, the severity of tiredness can vary from mild tiredness to severe exhaustion (also known as fatigue) with significant impact on the quality of life and affect wellbeing.

Are tiredness and fatigue the same?

In layman terms, tiredness and fatigue are often used interchangeably. However, speaking in medical terms, there is a difference between these two.

How tired is too tired during pregnancy?

Tiredness is experienced by everyone after certain activities, such as a long day at work or activities. Usually, simple tiredness resolves with taking adequate rest and sleep.

On the other hand, fatigue is defined as a feeling of consistent lack of energy every day. This unusual exhaustion does not go away after taking rest or after adequate sleep.

What does pregnancy fatigue feel like?

Unlike simple tiredness, the symptoms of fatigue can prevent a pregnant woman functioning normally and affect the quality of life.

About 60% of pregnant women complain of fatigue in the third trimester of pregnancy. and approximately 67% in the postpartum period.

But fatigue symptoms are often ignored as ‘expected’ part of pregnancy and parenting.

How long does the tiredness last in early pregnancy (first trimester)?

Tiredness and fatigue are often one of the first or earliest symptoms of pregnancy.  

The symptoms of pregnancy fatigue in the first trimester usually subside by 12-14 weeks of pregnancy.

However, sometimes this may continue to stay during the rest of pregnancy or recur again in the third trimester.

Causes of fatigue during pregnancy:

The exact reason for fatigue during pregnancy is unknown.

Some medical conditions can cause fatigue. These include anaemia, infection, hypothyroidism (‘underactive thyroid), insomnia, depression (both antenatal and postpartum), stress and chronic fatigue syndrome.

Physical inactivity/ lack of exercise is an important contributory factor for fatigue.

However, fatigue itself can be a barrier to physical activity and exercise.

Symptoms of fatigue may be worse if the woman is carrying multiple pregnancies (such as twins).

What causes fatigue during the first trimester of pregnancy?

Symptoms of fatigue can start in the first trimester of pregnancy and often worse during the evening.

Hormonal changes, such as high levels of the hormone progesterone have been implicated for fatigue during the first trimester. Progesterone is thought to cause tiredness and sleepiness.

A drop in blood sugar and blood pressure may also contribute to a lack of energy.

Pregnancy sickness/ hyperemesis can result in poor food and fluid intake, therefore, can cause lethargy and fatigue.

Initial weeks of pregnancy can be a time for an emotional roller-coaster. Sometimes, these can lead to stress and anxiety, which in turn can worsen tiredness and fatigue.

What causes fatigue and tiredness during pregnancy in the second trimester?

In many women, tiredness and fatigue get better in the second trimester, as early pregnancy symptoms (such as sickness) usually improve. This is the reason why sometimes the second trimester is also called “The Happy Trimester”.

However, some women continue to suffer from fatigue, especially if they have an untreated medical condition (such as anaemia). In many cases, the symptoms may be less severe though.

What are the causes of fatigue or tiredness during pregnancy in the third trimester?

Pregnancy ailments such as pelvic girdle pain, insomnia and frequent urination during the third trimester may worsen fatigue symptoms. The pregnancy discomforts may worsen as it approaches the due date due to the growing weight of the baby (fetus).

However, underlying medical conditions should be ruled out if the symptoms are worsening.

Can fatigue be harmful to the baby or pregnancy outcomes?

Pregnant women should be reassured that tiredness and fatigue are very common and in the majority of cases they do not cause any medical complication.

However, severe fatigue can make daily functioning very difficult. There can be a lack of motivation and concentration too.

These may lead to low social interaction and the ability to provide infant care and self-care. As a result, the woman may develop low self-esteem and poor quality of life.

Research has suggested that rarely fatigue may be associated with an increased rate of gestational hypertension, glucose intolerance/ diabetes, preterm birth, antenatal and postnatal depression.

Can fatigue increase the chance of Caesarean birth?

In general, fatigue symptoms do not interfere with labour and birth.

However, there are some suggestions that severe fatigue during the third trimester also thought to be associated with increased labour pain, prolonged labour, increased Caesarean births.

What is the impact of pregnancy fatigue at work?

Severe fatigue symptoms may cause difficulty at the workplace due to lack of energy, motivation and poor concentration.

If the tiredness and fatigue are interfering with your work, please speak to your colleagues and the line manager for possible modification of the type of job.

How the severity of fatigue can be assessed during pregnancy?

Fatigue is a subjective experience; therefore, the assessment can be best achieved by a self-reported scale.

16-item Multidimensional Assessment of Fatigue (MAF), validated for rheumatoid arthritis patients, has been proposed for using in pregnancy with good results.

Such assessment tools can identify women with severe fatigue and preventative measures can be taken to prevent complications, raising awareness of the partners/ family members for the emotional needs (Ref)

What are the coping strategies for fatigue? How to combat pregnancy fatigue? What helps with extreme fatigue during pregnancy?

First of all, pregnant women should not be alarmed if they suffer from tiredness and fatigue as they are common symptoms and in a vast majority of cases they are otherwise harmless.

If the symptoms worsen, assessments should be carried out to exclude any underlying medical condition or mental health problem.

The following strategies can help to cope with the symptoms:

1. Good sleep pattern and rest:

Having adequate sleep is key. A daytime nap can be helpful too. Trying to avoid drinking too much fluid before bedtime can be helpful. This will reduce the number of night time waking for urination.

2. Good nutrition:

Having a balanced healthy diet during meals and snacks are vital to meet the increased demand during pregnancy.

The adequate fluid will also help to avoid dehydration which may worsen fatigue.

3. Daily routine and work schedule:

It is useful to assess daily activities which are too tiring and adjust day-to-day activities accordingly.

Getting help from family members and friends may be helpful.

Speaking to your manager and colleague may help in readjusting workplace commitments.

4. Exercise and physical activity:

Research has shown that regular physical exercise is beneficial in overcoming fatigue.

It could be challenging to get the motivation to do physical activity and exercise due to the constant lack of energy and exhaustion.

Measures to stay active, such as going for a walk or swimming can be helpful.

5. Speak to others:

Sharing your feelings with trusted family members and friends can help.

As the symptoms are common, please do not feel you are alone.

6. Counselling:

In rare cases, psychological counselling may be required, especially if the fatigue is associated with stress, anxiety and depression.

7. Alternative medicine:

Some research has suggested that reflexology may help in reducing fatigue symptoms during pregnancy.

8. Relax:

Please take time to relax whenever possible, especially before going to bed. This would ensure a good night sleep.

Taking a warm bath, listening to relaxing music and avoiding computer work or spending too much time on the mobile phone may help.