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Your 2nd Trimester

The changes that pregnancy produces in women, affects every organ system in the body. Some changes are positive while others can be sometimes painful and even embarrassing. Dr. Margit Lister, OB-GYN at North Ogden Clinic in Utah, describes many of the changes you can expect during the second trimester of your pregnancy, starting with the top of your head.


Hair: It is a well known fact that women's hair gets thicker during pregnancy and then seems to completely fall out at an alarming pace at about 2-4 months after delivery. Why is that? First, this has nothing to do with prenatal vitamins. I have patients tell me all the time that they want to continue to take their prenatal vitamins because they like the way it makes their hair grow. Anyway, your hair has a growing phase and a resting phase. All the hairs on your head are either in one of these cycles. While you are pregnant, the majority of your hair goes into the growing phase and after you deliver, the majority of your hair goes into the resting phase. Once in the resting phase for about 3 months, the hair falls out and a new hair will grow in its place. This process will correct itself in 6-12 months.


Skin: You get brown marks on your face when you are pregnant. Why is that? Hyperpigmentation (or darkening of the skin) occurs in 90% of all pregnancies. It usually occurs in areas where there are increased melanocytes in the skin. Melonocytes cause your skin to darken. If you have a dark complexion, you have more melanocytes in your skin than if you are fair-skinned. Areas of your body that will darken with pregnancy are your areola of your nipples, umbilicus, vulva and perianal skin. Your linea alba (white line on your belly), will darken to the linea negra with pregnancy. Moles, freckles and scar tissue may also darken as the pregnancy progresses. Dark patches of skin (melasma) on the face are common in 70 % of pregnancies and are usually avoided with proper sun screen. Most of the time these fade with the end of the pregnancy.


Stretch Marks: What can we do? I wish I knew a cure! Stretch marks begin in the late 2nd trimester. They are typically found in the abdomen, breasts, and thighs. There is no cure but they will usually fade with time. Things you can do to limit your stretch marks is watch your weight gain (no more than 30 lbs) and look at your mother. If she has lots of stretch marks, think about giving up your bikini modeling, because you will likely get them with your pregnancy no matter what you do.

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Eyes: Does my vision change with pregnancy? There is an increase in corneal thickness which starts early in the second trimester and regresses by about 6 weeks postpartum. This change is thought to be caused by corneal edema (swelling). This may cause problems with contact lens wearers. You should not change your prescription of your contacts or glasses while pregnant. Wait until a few months after delivery.


Syncope: I passed out while I was pregnant, is there something wrong with my heart? Feeling lightheaded or dizzy when you are pregnant is not uncommon. One of the hormones of pregnancy, progesterone, relaxes smooth muscles. (The largest smooth muscle being the gravid uterus, which we don't want expelling its contents before its time!) Unfortunately the body has many areas that have smooth muscles and your vascular system is largely affected by progesterone. The smooth muscles of the blood vessel in your legs do not squeeze like they should when you are pregnant, so blood pools in your feet and your brain says 'Hey, I'm not getting enough blood" and you feel like you will fall down. If you don't sit down, you will fall, but when you become horizontal then the problem of no blood getting to the brain corrects itself, and you quickly feel better. So, the moral of the story is 'if you feel dizzy or lightheaded while pregnant, SIT DOWN.' If you don't, you will fall down and you could hurt yourself or the baby when you fall. How to prevent this is to wear compression stockings, drink plenty of fluids and try not to stand still for long periods of time.


Nausea: Why do you have morning sickness with pregnancy? Unfortunately we do not understand why pregnant women are nauseated. Morning sickness is a misnomer, since women may be nauseated at any time of day. It usually begins between 5-8 weeks and resolves by week 15. The thing that women need to keep in mind, is that women who have nausea and vomiting with pregnancy are less likely to miscarry than women who do not. And you have a 56% chance of having a girl than a boy.


Pica: I had strange cravings while I was pregnant, is there something wrong with me? No, you are normal, even if you ate dirt. Cravings during pregnancy are a common phenomenon and nothing to be concerned about. It is also common to eat nonfood substances with pregnancy, including but not limited to ice, clay and starch. As long as the rest of your diet nutritionally adequate, it is not a sign of concern. Learn about good nutrition during pregnancy.

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Heartburn: If I have a lot of heartburn, will my baby have a lot of hair? Not likely. Heart burn is caused by ever expanding uterus and the smooth muscle relaxing hormone 'progesterone'. Both of which will resolve with delivery. Eat smaller meals, avoid spicy foods, don't eat prior to going to bed, sleep slightly upright and use antacids as necessary.


Constipation: Things have stopped, what can I do? Constipation is also common with pregnancy. Progesterone is the culprit again. Progesterone decreases the contraction of the smooth muscles and this also affects the gut. Progesterone slows the 'squeezing' of the bowels which in turn increases the time the food stays in the intestines. Drink plenty of water and increase the amount of fiber in your diet. If you can prevent constipation, it will decrease the likely hood of developing hemorrhoids.


Round Ligament pain: I have this sharp, stabbing pain in the side of my belly, is there something wrong with the baby? No, this is round ligament pain. It typically feels like you are being stabbed in the abdomen with a knife and is extremely painful for 2-5 seconds, then quickly resolves and you have a residual ache in the same area for 10-15 minutes. Usually happens when lying down and changing positions, or moving suddenly. There is good news and bad news. Good news: There is nothing wrong with you or the baby. Bad news: This is really painful and there is little that can be done about it. Round ligament pain is caused by a stretching of the ligaments that hold the uterus upright. These ligaments are typically about 3 cm in the non-pregnant state and stretch to a length of greater than 10 cm in the pregnant state. Any movement that pulls these ligaments further is rewarded with intense pain and a sudden urge to return to the previous position that had no pain associated with it!

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Backache: My back aches all the time, is there anything I can do? First, does your back pain come and go? Or do you have pink or red vaginal spotting? If so, go see your doctor. This could be a sign of pre term labor and not typical back pain associated with pregnancy. Back pain is extremely common as your body adjust to the growing uterus and relaxation of your hip joints. As the uterus enlarges, it makes a larger curve in your lower back (called lordosis). This keeps your center of gravity over your legs while you are pregnant. Things that you can do to minimize your discomfort are decrease the time you spend standing, wear pregnancy support belts, physical therapy and Tylenol. Avoid high heels and wear shoes with good support. Ask your doctor about some pregnancy related exercises that you can do to help minimize the back discomfort.


Leg cramps: I wake up in the middle of the night and have to stand up to make my legs stop hurting, is this normal? Unfortunately yes, leg cramps happen to about half of pregnant women. They are more frequent at night and usually occur in the calves (lower leg). Suggestions of increase water intake, calcium and potassium have all been tried with little help. Massage and putting the muscle on stretch will usually relieve the discomfort.


Swelling: I can't fit into my shoes anymore. Is there something I can do to help with the swelling of my ankles and feet? Swelling in the legs is very common with pregnancy. It is caused by the gravid uterus and the hormone of pregnancy, progesterone. This typically happens in the second and third trimester. Check with your doctor to make sure that your blood pressure is within the normal range. Otherwise, wear compression stockings-this will push the fluid back in your veins and decrease the swelling. Elevate your leg. Gravity will push the fluid back into your legs. Watch your salty food intake-salt will make you retain water. Try not to stand for long periods of time- this will make your legs swell and eventually make you dizzy/lightheaded.


Dr. Margit Lister is a practicing OG-GYN at North Ogden Clinic, North Ogden, Utah.

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