WEBVTT - 210. Fatigue in Pregnancy 0:00:03.680 --> 0:00:06.760 Welcome to the Kick Your Expert led podcast, helping you 0:00:06.840 --> 0:00:11.240 explore and learn everything about gettingant, pregnancy, birth, and becoming 0:00:11.280 --> 0:00:11.680 a parent. 0:00:12.000 --> 0:00:15.760 On the podcast and our online pregnancy program grow My Baby, 0:00:15.960 --> 0:00:18.920 we share my experience of helping more than four thousand 0:00:18.960 --> 0:00:19.520 babies to. 0:00:19.480 --> 0:00:22.160 Be born, and our experience of running a women's health 0:00:22.200 --> 0:00:23.920 clinic and parenting for boys. 0:00:24.160 --> 0:00:27.160 We're here to help everyone to feel empowered in pregnancy 0:00:27.280 --> 0:00:30.120 and birth with real life, practical information. 0:00:32.440 --> 0:00:34.640 Welcome everyone. I'm Bridgid Maloney and. 0:00:34.560 --> 0:00:37.200 I'm obstetrician Dr Patrick Maloney. 0:00:36.800 --> 0:00:41.159 And today we're talking about a universal symptom. While I 0:00:41.159 --> 0:00:47.559 think it's universal, people feel so fatigued in pregnancy and 0:00:48.640 --> 0:00:51.519 it's universal. Good, And they say, why am I always 0:00:51.680 --> 0:00:52.560 so tired? 0:00:52.800 --> 0:00:53.920 Oh? Tired? Good? 0:00:54.000 --> 0:00:57.240 All right, I want to start with Pat. Why is 0:00:57.720 --> 0:01:02.320 something like fatigue so easily dismissed in pregnancy? 0:01:03.160 --> 0:01:07.400 Well, I think that people just know that pregnant women 0:01:07.440 --> 0:01:11.000 are tired, so it's easy to say, well, you're pregnant. 0:01:11.000 --> 0:01:14.120 There you go, that's the new normal. That's the way 0:01:14.120 --> 0:01:18.600 it is. And I think we need a better framework 0:01:18.640 --> 0:01:20.200 than that. We probably need to be saying right, oh, well, 0:01:20.200 --> 0:01:21.720 hang on a minute, let's make sure that there's nothing 0:01:21.760 --> 0:01:27.000 else wrong with you. Yeah, and then if it is 0:01:27.800 --> 0:01:32.520 just pregnancy fatigue, how can we help manage that in 0:01:32.560 --> 0:01:35.280 a way that's constructive and helps the people around you 0:01:35.520 --> 0:01:37.440 help you in the way that they can ye. 0:01:37.959 --> 0:01:40.200 So in this episode, we're going to go through the 0:01:40.280 --> 0:01:45.200 different stages of pregnancy and link the fatigue around those 0:01:45.200 --> 0:01:48.080 different stages and what might be happening. 0:01:49.520 --> 0:01:49.960 For you. 0:01:50.800 --> 0:01:52.800 How often do people come in and say, look, I 0:01:52.800 --> 0:01:54.480 am just so tired. 0:01:55.360 --> 0:02:00.480 Well, I think that it's nearly universal in the first trimester, 0:02:01.880 --> 0:02:04.160 and people expect the noise you're in volmiting because we 0:02:04.200 --> 0:02:06.520 all know about that, But that doesn't happen to everybody. 0:02:07.080 --> 0:02:09.480 Most people get a bit, some people get tons, and 0:02:09.600 --> 0:02:14.280 a few lucky people get nun but everyone is tired, yeah, 0:02:14.720 --> 0:02:16.560 almost without exception. 0:02:17.280 --> 0:02:20.520 And it's a bit shocking, isn't it that it happens 0:02:20.560 --> 0:02:22.560 so soon as soon as you find out you're pregnant. 0:02:22.600 --> 0:02:24.440 Pretty much, it's just like a switch goes on and 0:02:24.480 --> 0:02:24.920 you go poop. 0:02:25.160 --> 0:02:28.040 Well, it's how some people find out they are pregnant. 0:02:28.720 --> 0:02:31.560 They go, I've never felt this died in my life. 0:02:31.680 --> 0:02:35.640 Yeah, And I just want to describe that tideness for me, 0:02:36.120 --> 0:02:38.520 and that was really like I had been hit by 0:02:38.560 --> 0:02:41.720 a truck. Yeah, Like it was just that very much 0:02:42.080 --> 0:02:45.480 bone weary, tired, where I felt like I couldn't really 0:02:45.520 --> 0:02:47.840 even lift my arms up and. 0:02:48.600 --> 0:02:50.000 Just walk like it. 0:02:50.320 --> 0:02:52.240 And it wasn't the whole pregnancy, but just right at 0:02:52.240 --> 0:02:53.480 the start, that's how I felt. 0:02:53.760 --> 0:02:57.000 Yeah. Yeah, So this is thought to be related to 0:02:57.480 --> 0:03:05.480 higher levels of progesterone. And there's a a progesterone of 0:03:05.639 --> 0:03:15.000 pregnancy called pregnantanolone, which is quite active within our neurological system, 0:03:15.919 --> 0:03:20.120 and it's part of the brain's inhibitory pathway. So there 0:03:20.120 --> 0:03:22.160 are some things that fire us up and some things 0:03:22.160 --> 0:03:26.480 that settle us down. And progesterone in early pregnancy is 0:03:27.400 --> 0:03:35.440 calming and sedating and helps calm down excess firing of 0:03:35.440 --> 0:03:37.880 our brains in our nervous of our brain and nervous system, 0:03:38.400 --> 0:03:40.040 and it makes you sleeping. 0:03:40.320 --> 0:03:42.160 I don't expect you to know the answer to this, 0:03:42.320 --> 0:03:46.920 but from an evolution perspective, you think that that's really dangerous. 0:03:47.040 --> 0:03:48.000 I don't know what it's for. 0:03:49.360 --> 0:03:51.880 Like, you know, if you're in a tribe back in 0:03:51.920 --> 0:03:54.880 the day and all of a sudden you had all 0:03:54.880 --> 0:03:58.080 these sort of symptoms where you're really fatigued and stuff 0:03:58.480 --> 0:03:59.280 like you're a bit screwed. 0:03:59.440 --> 0:04:02.120 Yet on the African planes, it right, pick up all 0:04:02.120 --> 0:04:05.080 the pregnant where we're move to where the food's at, 0:04:05.760 --> 0:04:06.960 but they're too tired to come with us. 0:04:07.080 --> 0:04:10.120 Yeah, and you would think that, like, you know, back 0:04:10.520 --> 0:04:13.680 so at that early stage, some people like you said, 0:04:13.920 --> 0:04:15.840 the fatigue is the thing that makes them think am 0:04:15.880 --> 0:04:20.600 I pregnant? Yeah? But back in the day, would they 0:04:21.000 --> 0:04:21.880 put two and two together. 0:04:23.000 --> 0:04:25.920 I think that there are some of the physiological changes 0:04:25.960 --> 0:04:28.520 in pregnancy, the normal things that happened that that that 0:04:28.720 --> 0:04:31.640 you can see the point of it. But getting bone 0:04:31.680 --> 0:04:34.520 tied in the first time messages seems a bit cruel, 0:04:34.680 --> 0:04:37.839 A bit cruel, Yeah, especially if you're also horribly nauseator. Yeah. 0:04:37.960 --> 0:04:41.359 Yeah, and also not told anyone. So you're trying to 0:04:41.360 --> 0:04:44.880 go about your normal day, You're going to work, you're 0:04:45.600 --> 0:04:47.520 feeling like you needed to crawl under your desk and 0:04:47.560 --> 0:04:49.479 have a little nap, or you're doing an active job 0:04:49.560 --> 0:04:51.480 like you're a nurse or a teacher, on your feet 0:04:51.480 --> 0:04:54.880 all the time, Like I don't. It's I was lucky 0:04:54.920 --> 0:04:57.560 in my pregnancies where I could just sort of like 0:04:58.040 --> 0:05:00.279 zone out a little bit at a desk, but if 0:05:00.279 --> 0:05:02.200 I was in an active role, that would have been 0:05:02.320 --> 0:05:06.599 really challenging for sure. Right, So we've got first trimester 0:05:06.680 --> 0:05:10.880 pregnancy fatigue with progester owne issues. But I did see 0:05:10.960 --> 0:05:15.800 on Insta that your metabolism increases fifteen to twenty percent 0:05:15.880 --> 0:05:19.599 during pregnancy, and this is thought that's one reason why 0:05:19.600 --> 0:05:22.480 people get tired. But I thought fifteen to twenty percent 0:05:22.560 --> 0:05:24.520 for real, Like, I think we need to fact check that. 0:05:24.720 --> 0:05:27.599 Good well done, especially if it came from Insta. Yeah, 0:05:27.760 --> 0:05:32.080 so I think it's true that there are significantly increased 0:05:32.839 --> 0:05:36.200 metabolic demands when you're pregnant. So metabolic demand is just 0:05:36.200 --> 0:05:38.320 the energy required for your body to do all the 0:05:38.360 --> 0:05:40.599 things that it's doing. It's making a whole new person. 0:05:41.839 --> 0:05:45.160 But I don't think that your metabolism magically and at 0:05:45.160 --> 0:05:48.920 all times is able to is able to have a 0:05:48.920 --> 0:05:52.160 big uptick, big up to can pump that out in 0:05:52.160 --> 0:05:54.440 the way that it's needed. And perhaps that's where some 0:05:54.480 --> 0:05:56.120 of the deficit and the titness comes from. 0:05:56.240 --> 0:06:00.880 Yeah, and if some people put that like this was 0:06:00.920 --> 0:06:05.159 on a very well known birth educator's post, so if 0:06:05.160 --> 0:06:08.400 they put that together with okay, well, if my metabolism 0:06:08.440 --> 0:06:11.160 has increased fifteen to twenty percent, that means I do 0:06:11.240 --> 0:06:14.640 have to eat more. But that's not true really either. 0:06:14.680 --> 0:06:18.080 It's your calories. Additional calories do increase a little bit, 0:06:18.080 --> 0:06:19.400 but not to the point where you have to be 0:06:19.400 --> 0:06:21.240 eating fifteen to twenty percent more. 0:06:21.440 --> 0:06:25.320 Not at the start. No, no, So I always Metaiblism 0:06:25.400 --> 0:06:27.120 is a complex thing and it's not just fuel in 0:06:27.160 --> 0:06:31.919 one end and performance out the other. So in the 0:06:31.960 --> 0:06:39.600 first trimester, there's there's no increased caloric intake required, which 0:06:39.600 --> 0:06:42.400 is hand, isn't it, because you don't feel like eating anywhere. Yeah. Yeah, 0:06:42.520 --> 0:06:45.040 That's why I feel very very comfortable saying to people 0:06:45.160 --> 0:06:49.159 if you if you're horribly nauseated, eat fruit, eat fruit, 0:06:49.240 --> 0:06:53.239 tingles and salt and viniar chips and water, because that'll 0:06:53.279 --> 0:06:58.800 get some calories in, some water in and you'll get 0:06:58.839 --> 0:07:01.520 through the day. But it's not like you need to 0:07:01.560 --> 0:07:06.840 be eating tons of extra stuff follow that's it to 0:07:07.320 --> 0:07:11.480 have a healthy first trimester, And then there is you 0:07:11.560 --> 0:07:13.520 do need to be getting some extra calories in and 0:07:13.560 --> 0:07:16.880 the second and third t because you'll look at that, 0:07:17.040 --> 0:07:20.760 you know, the in the third trimester. The start of 0:07:20.760 --> 0:07:23.200 the third trimester that the baby's all formed but not 0:07:23.320 --> 0:07:25.720 very big, and then so the whole rest of the 0:07:25.720 --> 0:07:28.400 time is just all getting bigger. Yeah, now the ends 0:07:28.440 --> 0:07:30.559 you do, that's coming from somewhere, all right. Pad. 0:07:30.600 --> 0:07:33.600 So the next reason that this particular post said that 0:07:33.640 --> 0:07:37.080 people feel fatigued in first trimester was because the immune 0:07:37.080 --> 0:07:41.560 system had kicked in, and that feeling that the immune 0:07:41.600 --> 0:07:43.800 system was working in overtime sort of left your feeling 0:07:43.800 --> 0:07:45.800 like you had a mild cold all the time and 0:07:45.840 --> 0:07:47.880 that was increasing your tightness. 0:07:50.280 --> 0:07:53.880 That does not sound applausible to me at all. I 0:07:53.920 --> 0:07:56.280 think that your immune system definitely changes when you're pregnant. 0:07:56.840 --> 0:07:59.560 There are a number of important changes that your immune 0:07:59.600 --> 0:08:04.040 system needs to undergo, mostly so you don't reject your 0:08:04.040 --> 0:08:09.720 own baby, because the babies inside you it's half paternally derived, 0:08:09.720 --> 0:08:13.600 and it's and it's and so your immune system does 0:08:14.080 --> 0:08:16.360 function a bit differently, and if you look at some 0:08:16.640 --> 0:08:21.760 diseases with immune basis, they'll often function very differently. So 0:08:21.840 --> 0:08:26.240 people with say x ME, will often get better temporarily. 0:08:27.720 --> 0:08:34.200 Autoimmune conditions like a room toiter arthritis loopers asthma will 0:08:34.240 --> 0:08:41.280 often get temporarily better and then worse again afterwards. Thoroiditis, 0:08:42.440 --> 0:08:45.640 and these are due to changes in the way the 0:08:45.679 --> 0:08:48.840 immune system functions while you're pregnant. I'm not sure what 0:08:48.880 --> 0:08:51.040 the connection is with tiredness though, I don't I don't. 0:08:51.120 --> 0:08:55.120 I don't really see that, all right. I doubt that's accurate. 0:08:55.200 --> 0:08:58.160 I think I think that the immune system functions differently. 0:08:58.400 --> 0:08:59.559 I don't think that makes you tired. 0:09:00.440 --> 0:09:03.240 Okay, what about building more blood volume? 0:09:04.480 --> 0:09:06.280 Yeah, again, that's a thing. I'm not sure if it's 0:09:06.320 --> 0:09:11.000 related to tiredness. Definitely, you've built a lot more blood volume, 0:09:11.080 --> 0:09:15.280 so the blood volume increases significantly. It's got to fill 0:09:15.360 --> 0:09:21.440 up the placenta. And when you're pregnant, the physiological changes 0:09:21.440 --> 0:09:23.880 are very impressive. The cardiac changes are very impressive. So 0:09:25.440 --> 0:09:30.040 your rum heart rate is higher. The thing called stroke volume, 0:09:30.080 --> 0:09:32.080 which is how much your blood pumps out with each pump, 0:09:32.559 --> 0:09:36.240 is much higher, and there's a lot going along going 0:09:36.280 --> 0:09:40.520 on in your circulatory system. The exact relationship to tiredness, 0:09:40.559 --> 0:09:41.080 I'm not sure. 0:09:42.480 --> 0:09:44.840 I suppose, I don't know. Maybe they were positing that 0:09:44.920 --> 0:09:47.360 it's because your body is producing or making all this 0:09:47.440 --> 0:09:48.360 extra blood volume. 0:09:48.600 --> 0:09:51.160 Well, yes, I think, I mean, I think the most 0:09:51.160 --> 0:09:55.240 plausible connection to tiredness would be a hormonal one. Yeah, yeah, 0:09:55.360 --> 0:09:57.800 these other things are happening, doesn't mean to make it tired. 0:09:58.480 --> 0:10:00.960 I might be splitting hairs here, but it's but some 0:10:01.000 --> 0:10:04.840 of the stuff you read about pregnancy from non expert 0:10:04.920 --> 0:10:11.000 sources has a sort of a pseudo scientific face plausibility 0:10:11.640 --> 0:10:15.120 that actually is not under there's no there's no actual 0:10:16.720 --> 0:10:21.440 data or convincing mechanism of action behind it. So if 0:10:21.480 --> 0:10:23.240 you say your body's doing all these things and therefore 0:10:23.240 --> 0:10:26.839 you're tired, it's like, well, yeah, maybe, but I want 0:10:26.880 --> 0:10:28.079 to hear I want to know more. I want to 0:10:28.120 --> 0:10:30.840 hear more. How is that making me tie? 0:10:31.480 --> 0:10:34.040 It's so interesting, and you know, maybe we are sort 0:10:34.040 --> 0:10:35.480 of going down a rabbit hole a little bit. But 0:10:35.559 --> 0:10:38.240 if people are interested in this, go back and listen 0:10:38.320 --> 0:10:42.920 to our episode that we did on experts on social Media, 0:10:43.040 --> 0:10:45.240 you know, where we talked about if someone can say 0:10:45.280 --> 0:10:49.920 it really confidently and with certainly certainty, and people feel like, 0:10:50.200 --> 0:10:53.040 oh good, this person is in control. They know that 0:10:53.440 --> 0:10:56.160 you are tired in first tromester because you're doing X 0:10:56.280 --> 0:10:59.480 y Z. You know that that sort of gives people 0:11:00.120 --> 0:11:02.959 sense of calm in that. But you know, good, I'm 0:11:03.000 --> 0:11:05.360 glad that I've fact checked all those things with you. 0:11:05.440 --> 0:11:08.880 So you think in first trimester it's mainly progesterone, I 0:11:08.920 --> 0:11:09.280 think so. 0:11:09.640 --> 0:11:09.840 Yeah. 0:11:10.800 --> 0:11:15.280 And again we also talked about how you saying I 0:11:15.320 --> 0:11:21.160 think so, that's good science, Like without the data, you 0:11:21.160 --> 0:11:21.640 think so. 0:11:21.920 --> 0:11:25.560 Yeah, to the best of my knowledge, perhaps perhaps there 0:11:25.640 --> 0:11:29.840 isn't Perhaps no one knows for sure, but yeah, that 0:11:30.000 --> 0:11:34.280 is good science. Saying we don't know is a lot 0:11:34.280 --> 0:11:36.640 better than saying, here's something that sounds like it might 0:11:36.679 --> 0:11:40.679 be correct, and I will say it because it because 0:11:40.720 --> 0:11:43.000 I want to sound authoritative. 0:11:43.240 --> 0:11:47.400 Ye, all right, Pat. So the next thing is, I 0:11:47.400 --> 0:11:49.760 don't know if it's a myth or not, but mostly 0:11:49.800 --> 0:11:52.560 people say that they get their energy back in second trimester. 0:11:53.240 --> 0:11:56.920 Yeah, so that does tend to improve round about the 0:11:56.960 --> 0:12:00.600 time that the nausea and vomiting improve, about twelve weeks. 0:12:01.280 --> 0:12:03.640 And people will say, yeah, okay, fine, I'm back. I'm 0:12:03.679 --> 0:12:06.200 still not my old self, but I'm not that sort 0:12:06.200 --> 0:12:09.760 of deep bone tired that I was at ten or eleven weeks, 0:12:10.600 --> 0:12:15.320 and I've started to respond better to rest and can 0:12:15.400 --> 0:12:21.840 manage give or take my old day pre pregnancy day. 0:12:22.960 --> 0:12:26.480 All right, And what about for those people that you know, 0:12:26.840 --> 0:12:29.960 unfortunately don't say that they get any energy back and 0:12:30.000 --> 0:12:32.320 they have this ongoing fatigue. What are the things that 0:12:32.360 --> 0:12:33.400 you're looking for. 0:12:33.640 --> 0:12:35.040 Well, I think we just have to make sure that 0:12:35.080 --> 0:12:39.160 we're not dealing with someone who's tired completely for other reasons. 0:12:39.520 --> 0:12:41.520 So the two big ticket ones that we talk about 0:12:41.559 --> 0:12:49.920 a lot of hypothyroidism and iron deficiency anemia. So the 0:12:50.000 --> 0:12:54.160 hypothyroidism that it can be common in pregnancy, it can 0:12:54.200 --> 0:12:59.440 be subtle. Checking thyroid function is pretty easily done as 0:12:59.480 --> 0:13:02.240 a blood test. There are a number of sort of 0:13:02.280 --> 0:13:07.160 medical students style style examination findings that can indicate thorough disease, 0:13:07.200 --> 0:13:11.040 but they're often subtle, and in pregnancy, we want to 0:13:11.040 --> 0:13:13.960 pick them up long before the person's examination is abnormal, 0:13:14.280 --> 0:13:19.080 so we just do it by test. And iron deficiency 0:13:19.440 --> 0:13:25.320 and iron deficiency anemia is an interesting one. Everybody agrees 0:13:25.360 --> 0:13:27.640 that iron deficiency anemia i've got such the line that 0:13:27.640 --> 0:13:30.800 we're not making enough for blood cells and the hemoglobin 0:13:30.880 --> 0:13:34.040 is actually low, that that's a convincing form of tightness 0:13:34.760 --> 0:13:38.719 and should be treated. Not everybody agrees that iron deficiency 0:13:38.760 --> 0:13:43.360 with a normal hemoglobin is clinically significant, but most of 0:13:43.440 --> 0:13:50.560 us think that some people feel otherwise, but authoritative bodies, 0:13:53.440 --> 0:13:59.640 national Associations of Hematologists, red Cross, various blood experts nationally 0:14:00.640 --> 0:14:07.680 feel that iron deficiency in and of itself can be 0:14:07.720 --> 0:14:11.440 symptomatic even if the hemoglobin is still in the normal range. 0:14:11.880 --> 0:14:15.520 And is this where somebody might have low ferretin? 0:14:15.920 --> 0:14:21.160 Yeah, so the best, the most sort of useful measure 0:14:21.240 --> 0:14:24.800 on the iron test is called ferretin. And if we 0:14:24.880 --> 0:14:28.120 check the ferret and it's very low under thirty, especially, 0:14:28.440 --> 0:14:31.440 you know, especially if it's under twenty. You know, definitely 0:14:31.480 --> 0:14:35.920 if it's in single digits, that's likely to be symptomatic 0:14:37.000 --> 0:14:44.400 in the form of tiredness, decrease, exercise tolerance, sometimes lowered mood, 0:14:45.640 --> 0:14:48.840 even if the hemoglobin, which is all we used to check, 0:14:49.640 --> 0:14:51.640 is still up one hundred and twenty five and thirty. 0:14:52.120 --> 0:14:56.520 And if someone's having care where that practitioner is looking 0:14:56.520 --> 0:15:01.280 at their hemoglobin only and that hemoglobins, like, what can 0:15:01.320 --> 0:15:04.640 they do if they then still feel the same symptoms 0:15:04.680 --> 0:15:06.840 and still feel the fatigue, Can they ask to have 0:15:06.880 --> 0:15:08.000 their ferret and check for sure? 0:15:08.040 --> 0:15:11.360 You can? You can definitely ask at a local doctor 0:15:11.480 --> 0:15:15.560 or in an antenatal visit. I feel like my iron 0:15:15.680 --> 0:15:20.640 might be low even though my emoglobin's okay, and if 0:15:20.640 --> 0:15:22.600 that iron was low, I would be interested in having 0:15:22.640 --> 0:15:25.680 that treated. Remember, the iron in your pregnancy multivitamin is 0:15:25.720 --> 0:15:29.280 about enough to keep you going where you are because 0:15:29.280 --> 0:15:31.080 the baby's stealing lots of your irons. So if your 0:15:31.080 --> 0:15:34.320 iron's a hundred and you take the iron in the 0:15:34.640 --> 0:15:40.600 in the antenatal multivitamin, then the baby will keep on stealing, 0:15:40.640 --> 0:15:43.480 but you're adding some so it's going to state about hundred. 0:15:44.080 --> 0:15:46.920 But if your iron's ten, the baby will keep on stealing. 0:15:47.400 --> 0:15:50.200 The iron in the multivite won't be enough. You'll remain deficient, 0:15:50.920 --> 0:15:55.400 so you need that plus extra, and extra would be 0:15:55.480 --> 0:15:59.320 to take an iron tablet in addition to the multivite, 0:16:00.000 --> 0:16:01.440 which is hard to do every day. They tend to 0:16:01.480 --> 0:16:04.440 cause constipation so much every second day. And if we 0:16:04.440 --> 0:16:09.160 can see that in that intake is exceeding output, so 0:16:09.360 --> 0:16:12.400 we're getting more in than the baby stealing, then it'll 0:16:12.440 --> 0:16:16.520 come back up. But if that's still not working, or 0:16:16.560 --> 0:16:19.160 if the deaf deficit is so profound that we don't 0:16:19.160 --> 0:16:21.760 think it's going to have a reasonable chance of working, 0:16:22.160 --> 0:16:24.720 then sometimes we'll skip the gut and go straight to 0:16:24.760 --> 0:16:27.800 the intravenous iron infusion. 0:16:28.480 --> 0:16:33.720 And is it anecdotal. Yes, it's anecdotal. But I'm noticing 0:16:33.720 --> 0:16:37.840 that we're having a lot of our patients have iron infusions. 0:16:38.160 --> 0:16:41.160 Do you think it's a it's a sort of growing issue. 0:16:41.280 --> 0:16:43.720 Yeah, I think a few. It's a it's an interesting question. 0:16:43.800 --> 0:16:47.160 I think a few things have happened at once. There's 0:16:47.200 --> 0:16:49.560 always been iron infusions. But when I was a junior doctor, 0:16:49.560 --> 0:16:52.640 it's pretty awful they have an iron infusion. It really hurt. 0:16:53.640 --> 0:16:55.840 You got to be super duper careful that the vein, 0:16:56.360 --> 0:16:58.120 you know, you have the vein really well canulated so 0:16:58.160 --> 0:17:00.880 none of it leaked out, But mostly it hurt the 0:17:00.920 --> 0:17:02.800 patient as the iron went up there vein, and it 0:17:02.840 --> 0:17:06.879 was painful. So they were in general given to people 0:17:07.160 --> 0:17:11.800 who had chemo, who are having chemo, who had you know, 0:17:12.280 --> 0:17:19.719 a profound uh profound iron deficiency, or perhaps who wouldn't 0:17:19.800 --> 0:17:22.520 who needs really needed a blood transfusion, but but but 0:17:22.600 --> 0:17:26.880 wouldn't consider one for whatever reason. So it was a 0:17:26.920 --> 0:17:29.560 bit of a last resort. But then they invented one 0:17:29.600 --> 0:17:32.080 that didn't hurt, so, you know, give or take, it's 0:17:32.119 --> 0:17:37.400 a very well tolerated form of iron. And then at 0:17:37.400 --> 0:17:39.720 the same time, I think being a vegetarian, certainly in 0:17:39.760 --> 0:17:43.920 Australia is more popular with women in the pregnancy age 0:17:43.920 --> 0:17:49.119 group than it used to be. So for for you know, 0:17:49.520 --> 0:17:53.639 ethical reasons. Some a lot, a lot of women in 0:17:53.920 --> 0:17:59.560 the pregnancy years are not meat eaters for ethical reasons 0:17:59.800 --> 0:18:07.080 or for religious preference, or for that just turns them off. Yeah, 0:18:07.160 --> 0:18:10.160 there's a weird phenomenon where you might need red meat 0:18:10.200 --> 0:18:13.000 in early pregnancy. But that's the last thing possibly say. 0:18:13.040 --> 0:18:14.760 It can't stand the smell of it even cooking. Yeah. 0:18:14.800 --> 0:18:17.359 Yeah, so that's another one of those things that seems counterintuitive. 0:18:17.400 --> 0:18:22.359 And but so you know, in that cohort of women, 0:18:24.960 --> 0:18:30.879 they are likely to come into the more likely than 0:18:30.920 --> 0:18:32.639 other groups in the community to come into the pregnancy 0:18:32.680 --> 0:18:35.520 owned a fishon in the first place. Remember, they've often 0:18:35.560 --> 0:18:39.600 been menstuating everything, trying to have a baby. So a 0:18:39.680 --> 0:18:42.399 bunch of other young women who had iron deficiency, they 0:18:42.480 --> 0:18:45.720 might be treating that by having a marina and not menstruating, 0:18:46.040 --> 0:18:48.399 or be on the pill and menstruating less. But the 0:18:48.400 --> 0:18:50.080 group trying to have a baby, maybe they've been trying 0:18:50.119 --> 0:18:52.320 for six months, have been having a proper natural period 0:18:52.520 --> 0:18:56.560 for six months, eating no meat, get pregnant checkered iron 0:18:56.640 --> 0:18:58.520 fish fascinating. 0:18:59.040 --> 0:19:02.720 So apart from are there any other symptoms that you 0:19:02.760 --> 0:19:05.560 would expect with someone that has an iron deficiency. 0:19:05.480 --> 0:19:10.159 Well, the other symptoms are probably more related to iron 0:19:10.280 --> 0:19:13.600 deficiency anemia where it was sort of run out of iron. 0:19:13.600 --> 0:19:16.960 We're not making up for new red blood cells, and 0:19:16.560 --> 0:19:23.720 now the hemoglobin is actually low, so pale poor exercise 0:19:23.760 --> 0:19:28.600 tolerance can't walk up ill anymore. And occasionally we'll see 0:19:28.600 --> 0:19:31.679 this in a pregnant woman. It's much more common to 0:19:31.680 --> 0:19:33.520 see this in my job, in someone who comes in 0:19:33.560 --> 0:19:36.639 at forty seven forty eight with heavy menstrual bleeding from 0:19:36.680 --> 0:19:39.040 a big fire broad uterus and the GPS checked their 0:19:39.080 --> 0:19:42.240 hemoglobin and at seven where did it all go? Well, 0:19:42.240 --> 0:19:44.880 it just went a little bit more out each month 0:19:44.920 --> 0:19:47.600 than the woman could get in. Yeah, so she ate 0:19:47.600 --> 0:19:50.199 a bit of red meat but couldn't keep but was 0:19:50.240 --> 0:19:52.160 never catching up with how much she was losing through 0:19:52.200 --> 0:19:55.439 periods that had big clots or floods, and wake up 0:19:55.440 --> 0:19:57.399 in a puddle in the morning in bed and that 0:19:59.560 --> 0:20:03.240 incro mentally used up all the iron and then the 0:20:03.240 --> 0:20:06.800 hemoglobin start to fall. Our body's pretty good at adapting, 0:20:06.880 --> 0:20:11.040 so we just get a little you know, the oxygen. 0:20:11.080 --> 0:20:13.560 The hemoglobin carries oxygen from our lungs out to our body, 0:20:13.880 --> 0:20:19.480 and there's a thing called oxygen association curve where our 0:20:19.480 --> 0:20:21.800 body says, right, if they're not much hemoglobe will make 0:20:21.880 --> 0:20:24.639 it easier for the oxygen to leap off into the tissues, 0:20:25.200 --> 0:20:32.600 and so and so these all of these slight adjustments 0:20:32.640 --> 0:20:35.680 are made by our body as the iron gets lower 0:20:35.720 --> 0:20:37.919 and lower and the hemoglobin gets lower and lower. But 0:20:37.960 --> 0:20:39.640 then we get to a thing called slippery slope where 0:20:39.680 --> 0:20:41.280 we just can't managin it, manage it. 0:20:42.040 --> 0:20:44.040 I'm imagining all the thirty year olds that are listening 0:20:44.040 --> 0:20:46.840 to our podcasts and you say this happens when you're 0:20:46.880 --> 0:20:51.440 forty seven, forty eight, and they're like, no, something else 0:20:51.480 --> 0:20:57.159 I get to look forward to dear. All right, So 0:20:58.359 --> 0:21:01.040 you touched a little bit on mood. Much. Does mental 0:21:01.040 --> 0:21:03.920 health conditions impact on fatigue in pregnancy? 0:21:04.280 --> 0:21:07.560 Well? I think it's It works both ways, doesn't it. 0:21:07.600 --> 0:21:11.320 So if you've got a mental health issue that can 0:21:11.359 --> 0:21:17.600 manifest us fatigue, So people with depression feel tired, they 0:21:17.680 --> 0:21:21.920 feel uninterested in the things that used to get them 0:21:21.960 --> 0:21:26.400 fired up. There it's difficult to get out of bed 0:21:26.440 --> 0:21:29.679 in the morning. The day doesn't seem to hold the 0:21:30.880 --> 0:21:33.320 hold for them, the things that used to be worth 0:21:33.320 --> 0:21:36.600 getting out of bed for. And then it works in 0:21:36.640 --> 0:21:39.760 the other direction as well, in that if you are very, 0:21:39.840 --> 0:21:43.920 very tired, it makes any mental health issue you might 0:21:44.520 --> 0:21:45.840 have seem worse. 0:21:47.880 --> 0:21:52.320 And we are moving into third trimester now, and sometimes 0:21:52.320 --> 0:21:54.880 this fatigue comes back that you had in the first trimester. 0:21:55.240 --> 0:21:57.600 Yeah, why is that? Well, I think by then it's 0:21:57.720 --> 0:22:02.359 due to actual metabolic demand, an actual metabolic diffic deficits. 0:22:02.440 --> 0:22:04.359 So I think by then, your body's got a lot 0:22:04.400 --> 0:22:09.400 of work to do. That you're lugging around a three 0:22:09.480 --> 0:22:12.399 kilow baby and a and a and a placenta and 0:22:12.440 --> 0:22:15.240 all the extra water and then and the water around 0:22:15.240 --> 0:22:17.000 a baby, and then the water in your tissues and 0:22:17.040 --> 0:22:20.120 the and the and the swollen ankles, and then your 0:22:20.560 --> 0:22:24.040 brain is doing a lot of background work. It's processing, 0:22:24.320 --> 0:22:30.760 especially first baby, you're processing the mental load of the change. 0:22:32.119 --> 0:22:34.119 A lot of people find change tiring. 0:22:36.440 --> 0:22:39.679 I do, don't go there. 0:22:39.520 --> 0:22:45.000 Pat so they they So there's a lot going on 0:22:46.200 --> 0:22:50.200 and and and and that's a that's a different I think, 0:22:50.240 --> 0:22:52.560 a different form of tightness. That's that's not that's not 0:22:52.640 --> 0:22:56.400 home only driven like the first trimester one. It's it's 0:22:56.640 --> 0:22:59.800 it's literally like you're carrying around a big, heavy sack. 0:23:01.359 --> 0:23:03.920 Pat mentions the brain and the brain changes. If you're 0:23:03.920 --> 0:23:06.880 fascinated by that, go back and listen to our episode 0:23:06.880 --> 0:23:10.520 that we did with doctor Sarah Mackay, who's a neuroscientist. 0:23:10.560 --> 0:23:13.920 It's just really fascinating how the woman's brain is changing, 0:23:13.960 --> 0:23:18.520 particularly in the first pregnancy. Good, all right, what are 0:23:18.520 --> 0:23:20.199 some of the things people can do if they do 0:23:20.240 --> 0:23:22.040 feel this enormous fatigue. 0:23:22.600 --> 0:23:25.119 I think that it's worth reporting, So don't just how 0:23:25.320 --> 0:23:30.240 pregnant it's I'll be fine or no one cares. It's 0:23:30.280 --> 0:23:34.480 worth worth reporting because the akara would say, we'ld ask 0:23:34.520 --> 0:23:36.760 a few red flag type questions and then think, hang 0:23:36.800 --> 0:23:39.760 on a minute, perhaps we should be excluding organic disease, 0:23:40.000 --> 0:23:43.160 so let's make sure this isn't e deficiency, in deficiency, 0:23:43.200 --> 0:23:49.600