How do sleep patterns change in pregnancy?

Women do have functional changes in their sleep, and while a pregnancy-related sleep disorder is not a specific diagnosis, it has been proposed as a new categorization by the American Sleep Disorder Association. Disruptions such as positional discomfort, contractions, leg cramps, gastric reflux, and more frequent urination may lead to disordered sleep patterns. Changes in the amount of total sleep required is not uncommon. Typically the amount of sleep needed is increased in the first and second trimester and actually decreased in the third trimester. This may have to do with the patterns of sleep. The amount of REM and deeper staged sleep also changes in pregnancy.

Source: http://emedicine.medscape.com/

What hair changes are common during pregnancy?

Hair changes in pregnancy are very common, and body hair changes are common as well. Many women develop mild hirsutism that may be due to levels of male hormone production by the ovary and adrenal gland.

In nonpregnant patients, hair grows in the anagen phase and rests in the telogen phase. About 15-20% of all hairs are in the telogen phase at any given time. During pregnancy, however, more scalp hairs are in the anagen phase, so more growth is documented. During the telogen resting phase, it is normal for hair to fall out so new hair can regrow. During late pregnancy, fewer hairs are in the telogen phase; immediately postpartum, more hairs are in the telogen phase. This often results in a dramatic loss of hair immediately postpartum; this is termed telogen effluvium. Although this may be disturbing, it is normal.

Normal hair loss is probably in the range of 60-100 hairs a day and most patients do not notice a dramatic loss unless 40% of all hair is lost. This process spontaneously resolves in about 1-5 months, but has been reported to last more than a year. The frontal and parietal areas are usually most affected. No effective treatment is known.

Is liver disease more common during pregnancy?

Pregnant women can experience spider angiomata and palmar erythema. About two thirds of white women and only 10% of black women experience these symptoms. In addition, women may have reduced serum albumin concentration, elevated serum alkaline phosphate activity, and elevated cholesterol levels. These are common symptoms of liver disease, but they are not evidence of liver disease if they occur during pregnancy.

Is gallbladder disease more common during pregnancy?

Gallbladder disease may be more common during pregnancy. Estrogen is an important risk factor for gallstone formation; it increases the concentration of cholesterol in the bile leading to an increased risk of forming gallstones.

Source: http://emedicine.medscape.com/

What are common respiratory system changes during pregnancy?

Pregnant women experience nasal stuffiness due to estrogen-induced hypersecretion of mucus. Epistaxis is also common. The safest treatment of these symptoms is a saline nasal spray. The following is a summary of respiratory changes:

• Respiratory rate does not change.
• Tidal volume increases 0.1-0.2 L.
• Expiratory reserve volume (ERV) decreases 15%.
• Residual volume decreases.
• Vital capacity does not change.
• Inspiratory capacity increases 5%.
• Functional reserve capacity decreases 18%.
• Minute volume increases 40%.

Source: http://emedicine.medscape.com/

Is feeling the heart racing a common occurrence during pregnancy?

A significant number of cardiovascular changes occur during pregnancy, which may be accompanied by dyspnea and a reduced tolerance for endurance exercise. During pregnancy, women expand their blood volume by approximately 30-50%. This is accompanied by an increase in cardiac output. The heart rate may also increase by 10-20 beats per minute. The changes peak during weeks 20-24 and usually resolve completely within 6 weeks of childbirth.

The blood pressure in the upper extremities should change very little during pregnancy, but pressure in the lower extremities increases. This is accompanied by pedal edema. Because of extra blood flow, variances in the auscultated heart sounds may occur, such as murmurs, a wider split between the first and second heart sounds, or an S3 gallop. Some nonspecific ST-segment changes may occur, and some changes to the cardiac outline may appear on chest radiographs. The following is a summary of cardiovascular changes:

• Systolic blood pressure level decreases 4-6 mm Hg.
• Diastolic blood pressure level decreases 8-15 mm Hg.
• Mean blood pressure level decreases 6-10 mm Hg.
• Heart rate increases 12-18 beats per minute.
• Stroke volume increases 10-30%.
• Cardiac output increases 33-45%.

Source: http://emedicine.medscape.com/

Will changes in headache patterns occur during pregnancy?

For most women, headaches remain unchanged during pregnancy. Some women improve, but some may worsen. Because migraines have a hormonal component, many women's migraines improve with increasing estrogen levels, such as those that occur during pregnancy. For women whose conditions remain unchanged or worsen, treatment options are limited, especially in the first trimester. Some clinicians suggest acetaminophen, narcotics, and antiemetics. Nonpharmacologic treatments include relaxation strategies, eliminating stressors, and a good exercise program. These should first be attempted before pharmacologic therapy.

Source: http://emedicine.medscape.com/

Why does acne increase during pregnancy?

Studies show a variable effect of acne in pregnancy. If treatment regimens that were working prior to pregnancy were abandoned, the patient can have initial flares that are not directly related to the pregnancy. Some studies show that as many as a third of cases actually improve in pregnancy, but most women will report some worsening. Progesterone, which has some androgenic components, is increased during pregnancy, resulting in more secretions from the skin glands.

Postpartum, some women will get acne for the first time (called postgestational acne). Maintaining hydration should help. Women should consult their doctor if a topical medication is needed. Azelaic acid, topical erythromycin or clindamycin, and oral erythromycin are all safe. Although topical tretinoin has not been reported to cause risk, no studies have established it's safety and it should be avoided. Tetracyclines are contraindicated during pregnancy. Appropriate cleansing with mild abrasion aids has been found to be helpful.

Source: http://emedicine.medscape.com/

Do ocular changes occur in pregnancy?

Pregnant women report dry eyes, and some transient visual acuity changes have been reported as well. During pregnancy, the shift seems to be toward more far sightedness, and some corneal thickening can disturb contact wearers.

Source: http://emedicine.medscape.com/

Why do women undergo skin pigmentation changes during pregnancy?

Pigmentation changes are directly related to melanocyte-stimulating hormone (MSH) elevations during pregnancy. Some evidence suggests that elevated estrogen and progesterone levels cause hyperpigmentation in women. This is typically evident in the nipples, umbilicus, axillae, perineum, and linea alba, which darkens enough to be considered a linea nigra. More than 90% of patients have skin darkening. Facial darkening, called melasma, is a diffuse macular facial hyperpigmentation. When melasma occurs as a result of pregnancy, it is known as chloasma. This is due to the pigment being deposited in the epidermis itself. The distribution is usually malar but can be central or mandibular. Ultraviolet light exposure intensifies melasma and appropriate sunscreen decreases the effect. Because it is related to the hormones of pregnancy, it lessens with delivery.

Other pigmentation changes, such as palmar erythema, pseudoacanthosis nigricans, vulvar or dermal melanocytosis, or postinflammatory hyperpigmentation secondary to specific dermatologic conditions of pregnancy, are fairly common as well.

Source: http://emedicine.medscape.com/