Chronic fatigue in pregnancy

Why do we feel exhausted during pregnancy?

Considering that our bodies are busy making another human being cell by cell, it’s little wonder pregnant women feel exhausted. But why exactly do we feel so exhausted while we’re pregnant?

The reason is because the delicate balance of hormones that govern the menstrual cycle to get us pregnant in the first place is slightly out of sync for the first trimester. No longer focusing on preparing the body for a pregnancy, oestrogen and progesterone (produced in abundance now) focus on maintaining the pregnancy and adapting all the body systems for overload.

Increase in fluids

There is an increase in:

• Blood plasma (this can cause temporary anaemia),
• Blood fats (for the production of hormones by the placenta)
• Red blood cells (a call for extra oxygen)
• White blood cells (to boost the body’s immune system)
• Urine output (kidneys working overtime) - plus all this extra fluid means that the heart has to work a lot harder too.

Hormones, hormones, hormones

Hormones can influence your:

• Metabolism
• Sleep patterns (melatonin from the pineal gland in your brain)
• Energy levels (insulin production)
• Mood.

Other reasons why you may feel so tired is because you’re not sleeping properly and you may be more stressed in situations that previously may not have bothered you at all.

All of this is, of course, made even worse if you’re single, have an unsupportive partner or are running around after an active first child.

Feeling exhausted after giving birth

Don’t expect to spring back to normal after the birth either. Hormones need re-adjusting, you may be anaemic if you lost a lot of blood during or after the birth, your sleep pattern will be disturbed until your child’s a teenager (after which time you won’t sleep either because you’re worrying where they are). Your workload (despite disposable nappies and microwave meals) is trebled.

Breastfeeding alone burns 1 000 calories a day and you may even still be working from home too.

Will the fatigue lift?

Right now you may be asking yourself: Will I feel like this forever? For most of us, fatigue lifts a bit in the second trimester, energy levels may not return to pre-pregnancy levels, but you should start feeling a little more active. If you don’t, or you feel even more tired, talk to your doctor or caregiver because it could point to Chronic Fatigue Syndrome. 

Chronic Fatigue Syndrome

Causes of Chronic Fatigue Syndrome

• Heart disease 

Women who have been diagnosed with a heart condition before pregnancy are well aware of the importance of careful monitoring by a specialist throughout pregnancy. These conditions include rheumatic and congenital heart disease. Sometimes a heart condition is only diagnosed during the pregnancy.

Not only are these women exhausted, they may present with high blood pressure and general swelling. On diagnosis, they will be treated according to symptoms and will have to learn to rest, limit serious strenuous activities, limit salt intake, treat any infections promptly and be checked regularly throughout the pregnancy. 

• Anaemia 

A haemoglobin count less than 10.5g is classified as anaemia. Besides ongoing fatigue, symptoms during pregnancy include headaches, heart palpitations, looking pale and having brittle finger nails.

It’s important to find the source of anaemia. This could be nutritional (insufficient iron in the diet), malabsorption of iron from the diet, blood loss from hidden bleeding and diseases where the red blood cells are destroyed (congenital sickle cell anaemia, or thalassemia).

Treatment depends on the cause, and iron supplements combined with vitamin C (along with an iron-rich diet) is usually prescribed. Because it takes between 7 – 14 days for new red blood cells to be generated, don’t expect to feel better once treatment has started, for at least the next two weeks.

• Diabetes 

Besides always feeling very tired (due to lower blood glucose levels), symptoms of diabetes during pregnancy includes recurrent Candida (thrush) infections as well as other infections such bladder and urinary tract infections. There is also an increased risk of pregnancy-induced hypertension (high blood pressure).

Treatment means finding the cause, adjusting the diet, learning to keep a record of glucose monitoring and even learning to self-inject with insulin. 

• High / low blood pressure 

Women who are tired with high blood pressure also become swollen, gain excessive weight, have headaches, sometimes with visual disturbances. These symptoms should be reported to your doctor to prevent further complications.

Low blood pressure is usually temporary and symptoms include feeling dizzy (particularly when standing up quickly or after a hot bath), fainting and nausea. Low blood pressure could be caused by an underlying undiagnosed condition such as diabetes or anaemia so it’s important to tell your doctor about these symptoms.

• Lupus (SLE) 

Systemic Lupus Erthematosus is an autoimmune disease that may appear for the first time, worsen or even improve during pregnancy. The body’s immune system attacks connective tissue causing severe inflammation with symptoms that include feeling ill, very tired, feverish with appetite loss, nausea, joint pains and weight loss. The diagnosis is made on symptoms and blood tests.

Treatment depends on the severity of the condition. Before you phone your doctor in a panic, please remember that severe symptoms of fatigue with complications are extremely rare. Mention of these complications is made because they sometimes do happen, and the sooner treatment is prescribed, the sooner symptoms can be alleviated and complications can be avoided