REM (rapid eye movement) sleep is the term we use for deep restful sleep when people experience vivid dreams. Pregnant women actually experience more REM sleep and therefore may feel like they have more vivid dreams as well as more frequent dreams. Their sleep is also disrupted more often due to things like discomfort, restless legs, frequent urination, etc. Restless sleep can also lead to an increase in hypnagogic hallucinations, which are the abnormal sensations that occur right as you are falling asleep (like a sensation of falling, strange smells, etc.).

The result of all of this is that pregnant women tend to remember more of their dreams. Sometimes, our anxieties play themselves out in dream scenarios so it’s not uncommon for your dreams to contain content that might be disturbing (things like losing the pregnancy or your child being hurt or injured in some way). If you find that the content of your dreams is particularly disturbing, talk to your doctor

Mood swings are common in pregnancy and may be self-limited. Pregnant women are tired, often anxious about the pregnancy and the changes of life occurring, and are busy preparing for a new baby. There isn’t too much we can do for you here. But, it is important to distinguish an occasional mood swing from depression or anxiety. If you feel like your mood swings are uncontrollable and really, really bad, you should discuss them with your doctor so they can make sure that something more serious isn’t going on. The best way to take care of perinatal mental health problems is by catching them early. Many pregnant women, however, just have some overwhelming moments and don’t necessarily have an underlying mood disorder like depression or anxiety.

The best thing to do for these sorts of mood swings is personal soothing techniques. This might mean setting aside some personal time during your day or week, talking to your friends and family about things they can do to help you, or finding a confidant or therapist to talk things through with.  Mood swings are a part of pregnancy. There are a lot of changes going on with your body and your life. It is important to know that you can do this, and your doctor and your support system should be there to help every step of the way.

In the first trimester, certain hormones your pregnant body makes can stimulate urine production and the urge to pee. As the baby grows and the uterus expands, the bladder, located directly in front of the uterus, gets compressed. This means the bladder probably holds less urine before you develop the urge to pee. These forces conspire together to make pregnant women pee a million times a day. It is important to remember that if you feel you are peeing an unusual amount with burning, you might have a UTI. Talk to your doctor about doing a urine culture.

What can help you stop peeing so much, you ask? First, don’t stop drinking fluids. You need them to stay hydrated! But you can cut down on them right two to three hours before you go to bed to avoid so many nighttime interruptions. Avoid caffeine drinks if you can. In the third trimester, try positional changes to avoid compression of the bladder by the uterus.

Cutting out smoking completely is very difficult for most patients, but doing so can drastically reduce the risks to your pregnancy and your own health. There are a number of nicotine replacement therapies (NRT) such as: nicotine gum, patches, tablets, lozenges, inhalers (not the same thing as a vape), sprays, and strips. 

E-cigarettes are not a good option because they are not licensed or controlled for safety in pregnancy and we have no evidence that they are any safer in the long-term than cigarettes. 

Giving up smoking cold-turkey is hard. If you can give yourself time to quit gradually during the time when you are trying to get pregnant, this might be more effective. This involves reducing the number of cigarettes you smoke by one or two every week until you are completely off of cigarettes.

If you are pregnant and trying to stop smoking, you can also try substituting cigarettes with one of the NRTs mentioned above. This could mean using a patch and quitting all cigarettes or using an inhaler or gum and replacing a single cigarette here and there as you cut down. The goal is to get you to stop and stop for good, rather than quit for a week, and then fall off the bandwagon and start up all over again. 

When you are tempted to smoke, try the following:

• Delay the act of smoking as long as you can (and substitute it with an NRT if you can)
• Deep breaths
• Drink water
• Do something else (something with your hands is best)

We have medications that can help with the urges. Talk to your doctor to see if these are right for you.

There are lots of skin changes that might happen during pregnancy; some are due to physiologic and hormonal changes and some are more serious. Let’s talk about some of the more common ones.

Spider angiomas. These are little vascular spots that can show up on your skin during pregnancy. They are typically not concerning and will go away when you are no longer pregnant. The only time we would be concerned by them is if you have a history of liver problems or if you began having symptoms that would be concerning for a liver problem (which is rare). 

Linea nigra. This is a normal dark vertical line that can arise from your belly button down towards your pubic bone. It develops because of certain hormonal changes but it will fade away partially once the baby is born. During pregnancy, the placenta develops a hormone called melanocyte-stimulating hormone (MSH). This extra MSH stimulates some cells to make extra melanin which causes these cells to get darker.

Darkened areolae and darkened armpits. There are a lot of changes that may occur with the breasts during pregnancy. The nipples and areolae may become a darker shade due again to extra MSH. Similarly, the color should fade back to near its usual color after the baby is born. While this is completely normal, any redness of the breast should be investigated further by your doctor. The same thing goes for the arm pits. You may notice that they are darker, and may even look a gray or brown color. This is normal and will fade mostly back to normal as well once the baby is born. 

Melasma. Another case of hyperpigmentation in pregnancy! Are you kidding me?! Are you noticing a theme yet? Unfortunately, this one occurs on the face and women typically do not like it. It will appear as a gray or brown patchy/spotty or general change in the coloration of the face. What may be more upsetting to hear is that we don’t have a good treatment for it. If it’s still present a few months after you’ve delivered, talk to your doctor about possible treatments. You can prevent it from getting worse by using sun protection like sunscreens, hats, etc. Any sun exposure can make it worse. 

Polymorphic eruption of pregnancy (PEP). PEP is a rash of pregnancy that can occur during the third trimester on the abdomen and sometimes upper thighs. This previously was called pruritic urticarial papules and plaques of pregnancy (PUPPP). It will be very itchy and look like plaques, red bumps, or even hive-like. It can start out in the stretch marks and is not harmful to you or baby, but can be very annoying for you because of the itch. Treatment is a topical steroid cream that your doctor will prescribe for you, and possibly an oral antihistamine (e.g., Benadryl) to control the itch. Cool wet compresses and oatmeal baths may help with the itching.Pemphigoid gestationis. This rash can occur during the second or third trimester or sometimes right after delivery. This can have similar features to PEP but can extend further on your body beyond legs and thighs. It may develop blisters as well. The treatment is the same as it is for PEP. There are some other causes of rash and itching as well, including atopic eruption of pregnancy and pustular psoriasis of pregnancy. Remember, if your main symptom is intense itching without a rash, be sure to discuss intrahepatic cholestasis of pregnancy with your doctor as this requires medical treatment and earlier delivery.

Anything you normally do when you feel that way! Sit or lay down, have someone get you some water and food, and give yourself some time to let the feeling pass. Laying on your left side is best so that your uterus rolls off of the blood vessels bringing blood back to your heart. The most important thing is avoiding falling down and hurting yourself. So, as soon as you feel woozy or dizzy, sit or lay down on the ground or in a chair.

Most of the time, the problem is a lack of blood to your head. When you’re pregnant, blood tends to collect in your legs. Your blood vessels relax to allow for increased blood volume and your uterus puts pressure on the vena cava, which is the large vein that draws blood back from your legs to your heart. These factors mean that more blood stays in your legs and that blood has a harder time getting back to your heart. Because of this, there is relatively less blood going to your head sometimes and this may make you feel like you are going to faint.

Blood moves up from your lower extremities with movement of the muscles in your legs. The veins in your legs run through the muscles; when the muscles work, they squeeze the blood upwards back to your heart. So moving your legs helps whereas standing very still may contribute to you passing out. You also may want to wear compression socks to help blood flow and reduce swelling. You should certainly try to maintain good fluid and food intake throughout the day to keep your energy up. Also avoid heat like hot showers. Your blood vessels will dilate even more when you are hot and a really hot shower in the morning could cause you to pass out. Conversely, you might feel better with a cool rag on the back of your neck.

Some amount of bleeding during the first trimester is very common, affecting about one-third of pregnant women. Avoid sex if you are bleeding until you can discuss the bleeding with your doctor or it resolves. Bleeding increases your risk of miscarriage, but, surprisingly, not by very much. 

If you are having heavy bleeding and cramping, you need to be seen. Bleeding later in pregnancy may be a sign of labor or other problems. It can also be normal. A lot of women will spot later in pregnancy, especially if their cervix is starting to slowly make change. Always discuss heavy bleeding with your doctor immediately. This is almost never a reason to go the emergency department, but it is a reason to be seen in the office in the next day or two.

Cytomegalovirus (CMV) is a virus related to the herpes viruses. It is so common that up to 85% of adults in the United States have been infected at some point in their lives.

Usually, CMV is a mild disease that does not cause any serious problems in healthy children and adults. Most people get flu-like symptoms or cold-like symptoms for a few days, if they develop any symptoms at all. However, some people, including immune-compromised women and newborn babies of women infected with CMV during pregnancy, can have serious complications and even death.

Pregnant women infected with CMV for the first time during pregnancy can pass the virus to their unborn babies. The virus can also pass from mother to baby in vaginal secretions during delivery and in breast milk after birth. The virus can pass from person to person through blood, saliva, breast milk, and urine.

Up to 40% of babies born to women who are newly infected with CMV during pregnancy will become infected. Not all infected babies will have symptoms at birth.

Newborns with CMV are likely to be born early and weigh less. Other possible problems include a small brain (microcephaly) or other nervous system disorders that can cause seizures, deafness, mental retardation, or death. This infection can cause the liver and spleen to become larger than normal, as well as jaundice, and blood disorders. Newborns with CMV may have a rash that consists of small bruises called petechiae and larger bruises known as purpura. Some of these findings can be detected with ultrasound, but most cannot.

A baby born to a mother who was already infected with CMV before she became pregnant is less likely to be born with CMV due to some preexisting immunity. Only 0.5% to 1.5% of such babies are infected (compared to 40% of babies born to mothers who were infected during pregnancy), and their problems tend to be less severe.

There are currently no treatments for maternal or fetal CMV infection.

The pediatrician may order blood tests for babies with low birth weight, jaundice, small brains, or other problems that can be associated with congenital CMV. The diagnosis needs to be confirmed by testing blood or tissue from the infant within three weeks of birth to be accurate.

Young, healthy pregnant women usually do not need to be tested because they do not need to be treated specifically for CMV. They usually recover over a period of weeks. In some instances, blood tests may be done to confirm the cause of the illness, since similar symptoms can be caused by the Epstein-Barr virus (EBV) and even human immunodeficiency virus (HIV). Some of the antibody tests used to test for CMV have a high false-positive rate and the testing needs to be repeated to be reliable.

Pregnant women who care for young children should take these precautions to reduce the risk of CMV:

• Wash hands often with soap and water, especially after changing diapers. Wash well for 15 to 20 seconds.
• Do not kiss young children under the age of five or six on the mouth or cheek. Instead, kiss them on the head or give them a big hug.
• Do not share food, drinks, or utensils (spoons, forks, or knives) with young children.

If you are pregnant and work in a daycare center, reduce your risk of getting CMV by working with children who are older than two and a half years of age, especially if you have never been infected with CMV or are unsure if you have been exposed.