Maternal Health

Extreme Tiredness During Pregnancy

Medically reviewed by Dr. Lisa Okafor, MD, FACOG · Board-Certified OB-GYN

Content reviewed against published ACOG, NIH, March of Dimes guidelines

Editorial policy

Last reviewed:

Your health matters just as much as your baby's. If you are dealing with extreme tiredness during pregnancy, here is what you need to know.

The short answer

Extreme fatigue is one of the most common and earliest symptoms of pregnancy, affecting nearly all pregnant people at some point. It is caused by surging progesterone levels, increased blood production, metabolic changes, and the enormous energy demands of growing a baby. Fatigue is typically most intense in the first and third trimesters.

Key takeaways

  • Extreme fatigue is one of the most common and earliest symptoms of pregnancy, affecting nearly all pregnant people at some point. It is caused by surging progesterone levels, increased blood production, metabolic changes, and the enormous energy demands of growing a baby. Fatigue is typically most intense in the first and third trimesters.
  • Usually normal when: Feeling much more tired than usual, especially in the first and third trimesters
  • Call your doctor if: Sudden onset of extreme weakness, difficulty breathing, or chest pain
  • Varies by age — see the age-by-age breakdown below
“About 1 in 8 women experience symptoms of postpartum depression. If you have symptoms of depression that last longer than 2 weeks, tell your health care provider.”
— Depression During and After Pregnancy, Centers for Disease Control and Prevention (CDC)

Thousands of parents search for this exact thing. You are not alone.

What Parents Should Know

According to ACOG, NIH, March of Dimes guidelines, extreme fatigue is one of the most common and earliest symptoms of pregnancy, affecting nearly all pregnant people at some point. It is caused by surging progesterone levels, increased blood production, metabolic changes, and the enormous energy demands of growing a baby. Fatigue is typically most intense in the first and third trimesters. At First trimester, first-trimester fatigue can be overwhelming. Rising progesterone acts as a natural sedative, and your body is working hard to establish the placenta and support rapid fetal development. Rest when you can, go to bed earlier, and accept help. The fatigue is real and valid - listen to your body. It is generally considered normal when feeling much more tired than usual, especially in the first and third trimesters. However, you should contact your pediatrician promptly if sudden onset of extreme weakness, difficulty breathing, or chest pain.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
Feeling much more tired than usual, especially in the first and third trimesters
Sudden onset of extreme weakness, difficulty breathing, or chest pain
Needing to nap during the day or go to bed earlier than normal
Fatigue accompanied by yellowing of the skin, dark urine, or severe swelling
Fatigue that improves somewhat with rest and adequate nutrition
Fatigue is so severe that you cannot perform basic daily activities
Energy improvements in the second trimester
Extreme tiredness persists through the second trimester without any improvement

By Age

What to expect by age

First trimester

First-trimester fatigue can be overwhelming. Rising progesterone acts as a natural sedative, and your body is working hard to establish the placenta and support rapid fetal development. Rest when you can, go to bed earlier, and accept help. The fatigue is real and valid - listen to your body.

Second trimester

Many people experience a welcome boost in energy during the second trimester. Take advantage of this period if it happens for you. Continue eating well, staying hydrated, and exercising gently. If extreme fatigue persists without improvement, mention it to your provider to rule out anemia or thyroid issues.

Third trimester

Fatigue often returns in the third trimester due to the extra weight you are carrying, disrupted sleep, and the physical demands of late pregnancy. Take naps when possible, delegate tasks, and prioritize rest. Iron-deficiency anemia is common in the third trimester and can worsen fatigue - your provider may check your iron levels.

What to Tell Your Pediatrician

  • Describe when you first noticed extreme tiredness during pregnancy and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if fatigue is so severe that you cannot perform basic daily activities.
  • Mention if extreme tiredness persists through the second trimester without any improvement.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • Feeling much more tired than usual, especially in the first and third trimesters
  • Needing to nap during the day or go to bed earlier than normal
  • Fatigue that improves somewhat with rest and adequate nutrition
  • Energy improvements in the second trimester
Mention at your next visit when...
  • Fatigue is so severe that you cannot perform basic daily activities
  • Extreme tiredness persists through the second trimester without any improvement
  • Fatigue is accompanied by dizziness, shortness of breath, pale skin, or rapid heartbeat, which could suggest anemia
Act now when...
  • Sudden onset of extreme weakness, difficulty breathing, or chest pain
  • Fatigue accompanied by yellowing of the skin, dark urine, or severe swelling

What You Can Do at Home

  • Keep track of when you notice extreme tiredness during pregnancy — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that feeling much more tired than usual, especially in the first and third trimesters — this is generally within the range of normal.
  • At First trimester, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Prioritize your own rest and nutrition. Accept help when offered, and do not hesitate to reach out to your healthcare provider.
  • While monitoring at home, seek immediate care if sudden onset of extreme weakness, difficulty breathing, or chest pain.

Anemia During Pregnancy

Anemia during pregnancy is very common, affecting up to 40% of pregnant people worldwide. It is most often caused by iron deficiency due to the increased blood volume and iron demands of pregnancy. Symptoms include extreme fatigue, weakness, pale skin, dizziness, and shortness of breath. It is treatable with iron supplementation and dietary changes.

Thyroid Problems in Pregnancy

Thyroid disorders are the second most common endocrine condition in pregnancy. Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can affect pregnancy outcomes if untreated. Proper monitoring and treatment ensure healthy outcomes for both parent and baby. If you have a known thyroid condition, medication adjustments are often needed during pregnancy.

Insomnia and Sleep Difficulties in Pregnancy

Insomnia affects up to 78% of pregnant people at some point during pregnancy. It can be caused by physical discomfort, frequent urination, hormonal changes, anxiety, and difficulty finding a comfortable sleeping position. While frustrating, it is very common and there are many strategies that can help improve sleep quality.

Guide

Postpartum Recovery Guide

Week-by-week postpartum recovery timeline and warning signs.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is extreme tiredness during pregnancy normal?
Extreme fatigue is one of the most common and earliest symptoms of pregnancy, affecting nearly all pregnant people at some point. It is caused by surging progesterone levels, increased blood production, metabolic changes, and the enormous energy demands of growing a baby. Fatigue is typically most intense in the first and third trimesters.
When should I call the doctor about extreme tiredness during pregnancy?
Sudden onset of extreme weakness, difficulty breathing, or chest pain Fatigue accompanied by yellowing of the skin, dark urine, or severe swelling
When is extreme tiredness during pregnancy normal?
Feeling much more tired than usual, especially in the first and third trimesters Needing to nap during the day or go to bed earlier than normal Fatigue that improves somewhat with rest and adequate nutrition
What causes extreme tiredness during pregnancy?
Extreme fatigue is one of the most common and earliest symptoms of pregnancy, affecting nearly all pregnant people at some point. It is caused by surging progesterone levels, increased blood production, metabolic changes, and the enormous energy demands of growing a baby. Fatigue is typically most intense in the first and third trimesters. Common explanations include: Feeling much more tired than usual, especially in the first and third trimesters. Needing to nap during the day or go to bed earlier than normal.
What should I mention to my pediatrician about extreme tiredness during pregnancy?
You should mention extreme tiredness during pregnancy at your next visit if: Fatigue is so severe that you cannot perform basic daily activities. Extreme tiredness persists through the second trimester without any improvement. Fatigue is accompanied by dizziness, shortness of breath, pale skin, or rapid heartbeat, which could suggest anemia.
Is extreme tiredness during pregnancy normal at First trimester?
First-trimester fatigue can be overwhelming. Rising progesterone acts as a natural sedative, and your body is working hard to establish the placenta and support rapid fetal development. Rest when you can, go to bed earlier, and accept help. The fatigue is real and valid - listen to your body.
Is extreme tiredness during pregnancy normal at Second trimester?
Many people experience a welcome boost in energy during the second trimester. Take advantage of this period if it happens for you. Continue eating well, staying hydrated, and exercising gently. If extreme fatigue persists without improvement, mention it to your provider to rule out anemia or thyroid issues.
Should I go to the ER for extreme tiredness during pregnancy?
Seek emergency care if sudden onset of extreme weakness, difficulty breathing, or chest pain, or if fatigue accompanied by yellowing of the skin, dark urine, or severe swelling. When in doubt, call your pediatrician's after-hours line for guidance.
Does extreme tiredness during pregnancy go away on its own?
In many cases, extreme tiredness during pregnancy resolves on its own, especially when feeling much more tired than usual, especially in the first and third trimesters. By Third trimester, fatigue often returns in the third trimester due to the extra weight you are carrying, disrupted sleep, and the physical demands of late pregnancy. Take naps when possible, delegate tasks, and prioritize rest. Iron-deficiency anemia is common in the third trimester and can worsen fatigue - your provider may check your iron levels.
ACOGNIHMARCH OF DIMES

References

  1. [1]American College of Obstetricians and Gynecologists. Pregnancy FAQs: Exercise During Pregnancy. ACOG, 2022. ACOG
  2. [2]National Library of Medicine. Fatigue in Pregnancy. MedlinePlus, 2023. NIH
  3. [3]March of Dimes. Common Discomforts of Pregnancy. March of Dimes, 2023. March of Dimes

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Extreme Tiredness During Pregnancy.

Things to mention

  • Describe when you first noticed extreme tiredness during pregnancy and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if fatigue is so severe that you cannot perform basic daily activities.
  • Mention if extreme tiredness persists through the second trimester without any improvement.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Fatigue is so severe that you cannot perform basic daily activities
  • Extreme tiredness persists through the second trimester without any improvement
  • Fatigue is accompanied by dizziness, shortness of breath, pale skin, or rapid heartbeat, which could suggest anemia

Urgent signs to report immediately

  • Sudden onset of extreme weakness, difficulty breathing, or chest pain
  • Fatigue accompanied by yellowing of the skin, dark urine, or severe swelling

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

Related Resources

Feeding & Pumping GuidePregnancy TrackerBaby Tracker

Bottom line

Most cases of extreme tiredness during pregnancy are normal. Talk to your pediatrician if sudden onset of extreme weakness, difficulty breathing, or chest pain.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

Share:FacebookX

Was this page helpful?

Related Maternal Concerns

Anemia During Pregnancy

Anemia during pregnancy is very common, affecting up to 40% of pregnant people worldwide. It is most often caused by iron deficiency due to the increased blood volume and iron demands of pregnancy. Symptoms include extreme fatigue, weakness, pale skin, dizziness, and shortness of breath. It is treatable with iron supplementation and dietary changes.

Thyroid Problems in Pregnancy

Thyroid disorders are the second most common endocrine condition in pregnancy. Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can affect pregnancy outcomes if untreated. Proper monitoring and treatment ensure healthy outcomes for both parent and baby. If you have a known thyroid condition, medication adjustments are often needed during pregnancy.

Insomnia and Sleep Difficulties in Pregnancy

Insomnia affects up to 78% of pregnant people at some point during pregnancy. It can be caused by physical discomfort, frequent urination, hormonal changes, anxiety, and difficulty finding a comfortable sleeping position. While frustrating, it is very common and there are many strategies that can help improve sleep quality.

Dealing with Abnormal Prenatal Screening Results

An abnormal prenatal screening result can be terrifying, but it is important to understand that screening tests are designed to cast a wide net and have significant false-positive rates. Most people with abnormal screening results go on to have healthy babies after further testing confirms the baby is fine. An abnormal screening is a reason for more information, not a diagnosis.

Pregnancy Over 35 (Advanced Maternal Age)

While pregnancy after 35 carries some increased risks (including chromosomal abnormalities, gestational diabetes, and hypertension), the vast majority of people over 35 have healthy pregnancies and healthy babies. The term "geriatric pregnancy" is outdated and does not reflect reality. With appropriate prenatal care and monitoring, outcomes are excellent.

Amniocentesis Questions and Fears

Amniocentesis is a diagnostic test performed between 15-20 weeks that analyzes amniotic fluid to detect chromosomal conditions and genetic disorders with over 99% accuracy. The risk of pregnancy loss from the procedure is approximately 1 in 500-1,000 when performed by an experienced provider. Understanding the actual risks can help you make an informed decision.