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What causes second-trimester fatigue?

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How tired should I be?CausesWhen does it start?ManagementSummary
It’s common to feel tired during the second trimester of your pregnancy occasionally. But if your exhaustion doesn’t let up, you may need treatment for an underlying condition.
Medically reviewed by Stacy A. Henigsman, DO
Written by Anisha Mansuri
Updated on

It is common to feel fatigued at any point of your pregnancy, not just in your second trimester. This can result from health conditions such as anemia or sleep disorders. Recognizing the signs of fatigue can help you receive treatment more quickly.

Sex and gender exist on spectrums. This article uses the term “women” when discussing people assigned female at birth to reflect language that appears in source materials. 

While gender is solely about how you identify yourself, independent of your physical body, you may need to consider how your personal circumstances will affect diagnosis, symptoms, and treatment. Learn more about the difference between sex and gender here.

How tired should I be?

Pregnant woman laying down with her hands on her stomach to depict second-trimester fatigue.
Westend61/Getty Images

“When you’re expecting, it’s completely common to feel wiped out, especially as your pregnancy progresses into the second and third trimesters. After all, your body is busy growing a new human. But “while exhaustion might be a sign of pregnancy, you shouldn’t feel run-down for your entire 9 months,” says Mary Jane Minkin, MD, an obstetrician-gynecologist at the Yale School of Medicine.

“We expect women to report that they’re feeling more tired during the first trimester and the last couple weeks of their pregnancy,” says Dr. Minkin. “But if you’re normally the Energizer Bunny and you’re dragging during your second trimester or the first part of the third, we want to rule out an underlying medical issue.”

What can cause fatigue during pregnancy?

Several pregnancy-related health conditions can decrease your energy levels and leave you feeling fatigued. This includes:

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When you’re pregnant, your risk of iron-deficiency anemia increases. This means your body isn’t producing enough red blood cells to carry oxygen to your body’s tissues. “During pregnancy, you need double the amount of iron that you normally need,” says Dr. Minkin. This is because you’re carrying oxygen to the fetus, too.

Globally, more than one-third of pregnant people will get anemia.

Your risk can increase if you:

  • have had two pregnancies back-to-back
  • are carrying multiples, such as twins or triplets
  • regularly experience morning sickness

You may experience frequent headaches and mood changes, although these symptoms are common throughout pregnancy, regardless of whether you have anemia.

More telling symptoms of anemia include brittle nails, a sore tongue, and a craving for non-food items like clay, dirt, or ice. If you have symptoms of anemia, a doctor will run a test known as a complete blood count to measure your red and white blood cells.

Often, taking supplements like vitamin C and B12 can help treat anemia. Incorporating iron-rich foods like lean red meat, chicken, iron-fortified breakfast cereals, and dried beans into your diet can also help.

Thyroid disease

“Many symptoms of thyroid disease are also a common part of pregnancy, such as constipation and weight gain,” says Dr. Minkin. You should watch out for other thyroid symptoms, such as constantly feeling cold, muscle or joint aches, and trouble concentrating.

Up to 3% of pregnant people have low thyroid hormone levels during pregnancy, according to the American Academy of Family Physicians (AAFP). The condition is known as hypothyroidism. It can occur even if you’ve never had thyroid disease, explains Carolyn Cokes, MD, an obstetrician-gynecologist at Mercy Medical Center in Baltimore.

If hypothyroidism is left untreated, it can raise your risk of miscarriage and serious pregnancy complications. Complications include preeclampsia, a condition that causes high blood pressure and protein in your urine.

Fortunately, most cases of hypothyroidism during pregnancy are easily treatable.

A doctor will begin by ordering a blood test to measure for the hormone known as thyroid stimulating hormone (TSH). If your levels are outside the typical range, your doctor may prescribe a synthetic thyroid hormone, such as levothyroxine (Levoxyl).

In minor cases of hypothyroidism, a doctor may closely monitor your TSH levels to see if it changes by itself first.

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Sleep disorders

Experiencing a sleep disorder, such as insomnia and sleep apnea during pregnancy, can cause you to feel fatigued the next day.

Research from 2018 suggests that 15% of pregnant people worldwide have sleep apnea. It’s a serious condition that temporarily causes you to stop breathing while sleeping.

A common sign of sleep apnea is snoring, says Dr. Cokes. This may mean you are not sleeping as soundly as you think. Other symptoms of sleep apnea include mood changes and trouble concentrating.

Pregnant people with sleep apnea are at greater risk of complications such as preeclampsia and gestational diabetes.

A doctor will likely recommend a continuous positive airway pressure device (CPAP). This machine connects to a mask that covers your mouth and nose. It delivers a constant flow of pressurized air to keep your airway open while sleeping.

A doctor may also refer you to a sleep specialist for an overnight study, which can help confirm the diagnosis.

When does pregnancy fatigue start?

Pregnancy fatigue usually starts in the first 12 weeks, or first trimester. Some people may find that this continues into their second trimester as their energy levels drop. Some people find it more difficult to sleep at this point in the pregnancy as the fetus grows.

Many people also find they wake up lots of times during the night by the frequent urge to urinate. This can also disrupt sleep quality and cause fatigue the next day.

Tips to overcome pregnancy fatigue and get more energy

Ways to manage fatigue during pregnancy and have more energy throughout the day include:

  • Getting plenty of rest: Getting enough quality sleep at night can be difficult, especially during your second and third trimesters. This is why it can also be helpful to rest during the day.
  • Reduce your caffeine intake: Drinking caffeine can give you a short-lived burst of energy, making you feel even more fatigued. Limiting your caffeine intake, especially before bedtime, can help you get a more restful night’s sleep.
  • Eating foods high in iron: Your risk for anemia increases during pregnancy, which is why it can be beneficial to eat plenty of iron-rich foods, such as leafy green vegetables, lean meat, and lentils. This can also help decrease fatigue levels and give you much more energy.
  • Going for regular walks: Going on a walk may seem counterproductive when you are feeling tired. However, it can increase your overall energy levels and even help with other pregnancy-related symptoms, such as back pain.


Fatigue is common during pregnancy, as your energy levels typically drop. Reasons you might feel fatigued during the second trimester of your pregnancy include anemia or sleep disorders, such as insomnia.

You might also have difficulty sleeping during the second semester when the fetus is growing and pushing against the bladder. This can cause the frequent urge to urinate at night, which can disrupt your sleep quality and leave you feeling tired the next day.

If you regularly feel fatigued throughout your pregnancy, consider speaking with a healthcare professional. They can help identify if there is an underlying health condition that may be the cause.

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