What to Know About Fatigue in the First Trimester

Are you exhausted in the first trimester of pregnancy? Feeling like you could rest your head on the table during a work meeting and have a nap? Like you’re in a sleepy haze as you push your grocery cart down the aisles?

You can chalk it up to all the extra demands on your body and a hormone called progesterone. First-trimester fatigue is well-documented.

Almost 95% of women say they suffer fatigue during pregnancy, according to a 2021 Sleep Science study. The first trimester is usually the worst time for sleepiness.

Fortunately, you won’t likely feel this exhausted throughout your pregnancy. In fact, many women feel great once they hit their second trimester – which is why many call it the ‘golden trimester’. In the meantime, you can make simple changes in your day-to-day routine can help you feel more energized.

Why Am I Tired All the Time in the First Trimester?

Even though your baby may be the size of a plum — or even a pea —your body is working hard.

In the first trimester, your body makes a whole new organ — the placenta — which supports your baby’s growth throughout pregnancy. This placenta-building process lowers your blood pressure and blood sugar, leading you to feel extra tired.

Meanwhile, your body is producing a higher level of progesterone production than normal. This hormone encourages your uterus to release nutrients and stimulates milk ducts to get ready for breastfeeding. Progesterone can also send signals to brain transmitters that it’s time to switch off and sleep.

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When Does Fatigue in Pregnancy End?

While you continue to make high amounts of progesterone throughout your pregnancy, your body adjusts over time to it. So, by the time you reach 10 to 13 weeks, progesterone doesn’t have the same sedating effect.

Another reason fatigue improves is the placenta is fully formed by the end of the first trimester. That means your body’s resources aren’t going to build the placenta.

Most women find that fatigue gets better after the first trimester but then returns toward the end of the pregnancy. That’s because a kicking baby, heavy tummy, and late pregnancy aches and pains can make it harder to get any shut-eye.

While fatigue tends to lessen by the second trimester, you’re still supporting a growing pregnancy. So you may continue to feel throughout your pregnancy that you don’t have the same pre-pregnancy energy.

What Can I Do to Feel Less Tired in Pregnancy?

Getting serious about your bedtime routine, taking naps, exercising, and changing how you eat can all help.

Limit caffeine

When you’re exhausted in the first trimester, you might want to brew up a cup of hot java. But the American College of Obstetrics and Gynecologists (ACOG) says pregnant women should not exceed 200mg of caffeine in a day. That’s about the amount in a 12-ounce cup of average (not super strong) coffee.

The reason why you need to limit caffeine? Studies have linked caffeine in high amounts to lower fetal growth and pregnancy loss.

So you can have coffee in the morning, but don’t reach for more to get you through the day. You could try switching to tea, as a cup of black tea typically only has about 55 mg of caffeine.

Get some exercise

While you’re tempted to lie on the couch, exercising will give you a boost of energy that can last for hours afterward. This doesn’t mean you need to do step aerobics.

Exercise during pregnancy also improves your overall health and may reduce your risk of pregnancy complications, according to ACOG. Going for a walk, swimming, or yoga release endorphins that boost your mood and energy levels.

Take a nap

Lying down for 20 or 30 minutes when that afternoon slump hits can recharge you for the rest of the day. Experts warn, however, that long naps (more than 30 minutes) can make you feel groggier when you wake up. Plus, long naps can throw off your sleep schedule, making it tougher for you to fall asleep at night.

Eat smaller meals

Eating big meals can cause a spike in blood sugar, followed by an energy-zapping crash. For more energy, experts suggest trying five to six small meals a day, instead of three large meals. As an added bonus, this can help reduce nausea in the first trimester.

Try to get more protein, fruit and vegetables, and whole grains, because fiber and protein help steady your blood sugar. Eat less simple carbs (like white bread, cookies, and sugary drinks) that cause a spike and drop in your blood sugars.

Stick to a good sleep routine

Getting enough sleep at night helps combat daytime fatigue. Try to go to bed at the same time every night, as this will help you fall asleep faster.

If you’re struggling to fall asleep at night, keep the lights low and avoid screens one hour before bedtime. Do a calming activity, like reading, before bed. Getting enough exercise and exposure to daylight will also help your body settle in for sleep.

If you experience pregnancy nausea at night time, try eating crackers before bed. (Despite the name, morning sickness can indeed hit throughout the day and night).

Lighten your load

When you’re in the first trimester, you likely won’t be able to take on as much as you did pre-pregnancy. So don’t feel bad about asking your family members to help out more with domestic tasks.

See if you can outsource some tasks, like buying groceries through a delivery service. You can also save some errands for when you have more energy in the second trimester.

When Should I Worry About First Trimester Fatigue?

Fatigue is most likely due to the effects of progesterone and the added demand on your body. In some cases, however, extreme tiredness could be due to a health problem. These include anemia (too low iron), thyroid problems, gestational diabetes, prenatal depression, and other problems.

One way to tell the difference between normal and not-normal pregnancy fatigue is whether you can push through it. If you’re falling asleep at your desk by accident, or you’re too tired to drive safely, check in with your doctor.

You should also see your health provider if you have any worrying symptoms on top of fatigue, that could signify another health problem. These include like weakness, frequent urination, looking very pale, sudden weight changes, breathlessness, irritability, or anything else that worries you. Despite pregnancy being a huge change, not every symptom in pregnancy can be blamed on the pregnancy itself. Be empowered to emphasize to your doctor if you think something is outside the range of normal and has you concerned. In these circumstances, it is okay to ask if there are any tests that can be done to be reassured that your symptoms are within the realm of what is expected for a pregnant patient.

American Academy of Family Physicians. Sleep and pregnancy: Tips for a better rest. Link

American College of Obstetrics and Gynecology. Exercise during pregnancy. Link

American College of Obstetrics and Gynecology. How much caffeine can I drink while pregnant? Link

Colleen de Bellefonds. Fatigue during pregnancy. What to Expect. Link

Dr. Fatemeh Effati-Daryani et al. Fatigue and sleep quality in different trimesters of pregnancy. Sleep Science. Link

Sandee LaMotte. Smartphone addiction ruins sleep, study says, but you can fight back. CNN. Link

Sharlene Johnson. Handling a tough first semester of pregnancy. Parents. Link

About UPMC Magee-Womens

Built upon our flagship, UPMC Magee-Womens Hospital in Pittsburgh, and its century-plus history of providing high-quality medical care for people at all stages of life, UPMC Magee-Womens is nationally renowned for its outstanding care for women and their families.

Our Magee-Womens network – from women’s imaging centers and specialty care to outpatient and hospital-based services – provides care throughout Pennsylvania, so the help you need is always close to home. More than 25,000 babies are born at our network hospitals each year, with 10,000 of those babies born at UPMC Magee in Pittsburgh, home to one of the largest NICUs in the country. The Department of Health and Human Services recognizes Magee in Pittsburgh as a National Center of Excellence in Women’s Health; U.S. News & World Report ranks Magee nationally in gynecology. The Magee-Womens Research Institute was the first and is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology, with locations in Pittsburgh and Erie.