Pregnancy brings about many changes in a woman’s body. While some of these changes revert to pre-pregnancy state over time, many changes are long-lasting and can be permanent. Pregnancy puts the female body through tremendous physical stress, which leads to anatomical and physiological changes to accommodate the growing fetus. The body undergoes remarkable transformations to nurture and deliver the baby. Here we look at some of the key changes during and after pregnancy and how permanent they can be.
Weight Gain
During pregnancy, women typically gain between 25-35 pounds to provide for the baby’s growth and development. The recommended weight gain is based on the woman’s BMI before pregnancy:
| Pre-pregnancy BMI | Recommended Weight Gain |
|---|---|
| Underweight (BMI less than 18.5) | 28-40 pounds |
| Normal weight (BMI 18.5-24.9) | 25-35 pounds |
| Overweight (BMI 25-29.9) | 15-25 pounds |
| Obese (BMI 30 and above) | 11-20 pounds |
While many women can shed the extra pregnancy weight over time with diet and exercise, some weight gain is permanent. Factors like genetics, age, pre-pregnancy weight and lifestyle determine how much weight stays. Studies show that women retain about 1.5-6.6 pounds on average after pregnancy.
Changes in Breast Size
One of the first signs of pregnancy are changing breasts. They become swollen and fuller as the mammary glands prepare for lactation. The areolas darken and the Montgomery glands become more prominent. Breast size increases by 1-2 cup sizes during pregnancy. After delivery, the breasts remain enlarged for a while as they fill with milk. Once lactation ceases, the breasts deflate but don’t quite go back to pre-pregnancy size. The surrounding connective tissue stretches during pregnancy and does not regain its tautness. Additionally, milk glands and milk ducts remain enlarged post-weaning. These permanent changes translate to subtle but noticeable differences in breast size, shape, firmness and sag.
Stretch Marks
During pregnancy the skin over the abdomen expands rapidly to accommodate the growing uterus and baby. This stretching, coupled with hormonal changes, can rupture the collagen and elastin fibers in the skin leading to stretch marks or striae. Stretch marks are reddish linear scars that can occur over the abdomen, breasts, thighs, hips and buttocks. Though the angry red lines fade to silvery streaks postpartum, the textural changes in the skin remain permanent. Creams and dermatological treatments can improve their appearance but stretch marks never completely go away.
Skin Changes
Pregnancy hormones like estrogen, progesterone and cortisol cause a variety of skin changes that can persist postpartum. These include:
- Darkening of skin: Increased melanin causes darker pigmentation on facial skin and abdominal nipples. This typically fades but not completely.
- Acne and skin tags: Stimulated oil glands result in acne breakouts and skin tags. These gradually resolve though acne scars can be permanent.
- Linea nigra: Dark vertical line from pubic bone to mid-abdomen that usually fades but doesn’t disappear fully.
Changes in Hair Growth
During pregnancy, increased estrogen prolongs the anagen or growth phase of hair leading to thicker, faster-growing hair. However, post-delivery hair shedding occurs as estrogen levels drop and hair follicles reset to non-pregnant phases. Shedding peaks around 4 months postpartum. Hair eventually reverts to normal thickness but some women experience permanent changes in texture or color of new hair growth after pregnancy.
Weakened Pelvic Floor Muscles
The pelvic floor muscles provide support to the bladder, uterus and bowel. These muscles stretch and weaken during pregnancy and childbirth. Postpartum healing takes around 6-8 weeks but muscles shortened during late pregnancy can result in long-term stiffness and pain. Difficult labor, assisted delivery with forceps/vacuum and vaginal tearing can damage pelvic floor nerves and muscles leading to permanent weakness. Pelvic organ prolapse and urinary/fecal incontinence are common consequences.
Prevalence of urinary incontinence after pregnancy
| Time after delivery | Prevalence |
|---|---|
| First 3 months | 7-30% |
| 6-12 months | 4-6% |
| 5+ years | Up to 16% |
Changes in Foot Size
Feet tend to spread and flatten during pregnancy as ligaments loosen in response to weight gain and increased estrogen. It is common for women to move up by half to a full shoe size. Arches may fall permanently leading to flat feet. Bunions can develop due to the widened foot. In rare cases, pregnancy can trigger inflammation and nerve damage leading to permanent changes in foot size and shape.
Tooth and Gum Changes
Hormonal changes during pregnancy can exacerbate dental problems like gum disease and increase the risk of decay. Morning sickness and acid reflux can erode tooth enamel. Gingivitis is common during pregnancy leading to inflamed, bleeding gums. Postpartum women may be left with permanently increased gum recession and tooth decay if these issues remain untreated. Pregnancy can also permanently alter the structure of teeth and bite in some cases.
Abdominal Muscle Separation
As the uterus expands, it can cause the rectus abdominis muscles which run vertically along the abdomen to stretch and separate along the midline. This is called diastasis recti or abdominal separation. Postpartum, some degree of separation usually remains leading to muscle weakness and bulging. Wide separations that do not close with time may require corrective surgery such as abdominoplasty.
Prevalence of postpartum diastasis recti
| Weeks Postpartum | Prevalence |
|---|---|
| 6 weeks | 33-60% |
| 6 months | 39% |
| 1 year | 10-31% |
Scars from Cesarean Sections and Episiotomies
Surgical incisions from C-sections and episiotomies heal into permanent scars over time. Though the scar tissue fades and softens, it remains visible. Some women are left with thick, painful keloid scars. The residual numbness around the scar usually resolves but some tingling may persist.
Stretching of Abdominal Muscles and Skin
Even in the absence of diastasis recti, the abdominal muscles and skin undergo irreversible stretching during pregnancy. Postpartum skin lacks firmness and sags in areas like lower abdomen, hips and pubis. Residual loose skin is common after pregnancy even after losing the weight.
Darkening of Linea Alba
Linea alba is the fibrous connective tissue running down the midline of the abdomen. The linea alba darkens in color due to pregnancy hormones and abdominal stretching. It remains visible as a dark line postpartum.
Vaginal Changes
Hormone changes lead to increased blood flow to the vagina and vulva, making the tissues thicker and more elastic to prepare for delivery. The vaginal opening stretches significantly during childbirth which can cause some permanent widening and laxity. The perineum stretches and tissue layers separate to varying degrees causing diminished tone. Scarring from episiotomies and vaginal tears also contribute to postpartum vaginal changes.
Incontinence
Loss of bladder and bowel control is a common postpartum problem. Damage to the pelvic floor muscles and nerves during pregnancy and vaginal delivery can lead to urinary and fecal incontinence which may become permanent without treatment. Even a normal vaginal delivery involves some degree of trauma to the pelvic muscles which may predispose women to incontinence later in life.
Hernias
Increased abdominal pressure and muscular strain during pregnancy can cause abdominal muscles to separate and weaken over the linea alba. This impairs the muscle’s ability to hold organs in place and increases the risk of hernias developing. Umbilical hernia through the abdomen and hiatal hernia through the diaphragm into the chest are the most common types that can become permanent if not repaired surgically.
Back Pain
Back pain is common during pregnancy as weight gain, postural changes and hormones that loosen connective tissue put extra strain on the spine. Most postpartum back pain subsides but some women develop chronic pain from muscle dysfunction and ligament laxity aggravated during pregnancy. Prior injury, high BMI, strenuous labor and epidural anesthesia increase the likelihood of persistent back pain after pregnancy.
Varicose Veins
Varicose veins are swollen, twisted superficial veins which often develop or worsen during pregnancy. Increased blood volume, progesterone effects on blood vessels and uterine pressure on veins can cause permanent varicose veins and venous insufficiency later in life.
Spider Veins
Spider veins or broken capillaries under the skin’s surface also frequently emerge during pregnancy. Hormones and increased blood volume strain the walls of blood vessels causing them to dilate and appear as red/blue spider veins. Though they gradually fade postpartum, broken capillaries never fully disappear.
Hair Loss
Most women experience significant hair shedding around 3-4 months after delivery due to lowered estrogen. Hair loss regulates itself within 6 to 12 months as hormones rebalance. However, some women suffer from more extreme hair loss called postpartum alopecia that can be scarring and long-lasting.
Changes in Sex Life
Childbirth can affect a woman’s sex life in both positive and negative ways. Some experience decreased libido and arousal due to fatigue, hormones changes and body image issues. Vaginal dryness, scarring, pain and incontinence may hinder intimacy. However, some women report increased sexual confidence, lubrication and capacity for orgasms postpartum. Communication, pelvic floor rehabilitation and lubricants can help overcome any persisting issues.
Mood Changes
The roller coaster of hormones after pregnancy can heighten mood changes like postpartum depression, anxiety, irritability and psychosis in the weeks following delivery. Postpartum mental health issues are usually temporary but may become chronic without timely treatment and support.
Chronic Conditions
Some women develop long-term health issues linked to pregnancy complications like gestational diabetes and preeclampsia. These include a higher lifelong risk of diabetes and high blood pressure. Autoimmune disorders like rheumatoid arthritis sometimes first surface during or after pregnancy as well.
Conclusion
Pregnancy transforms a woman’s body in many ways. While few changes are consistently permanent, most women retain some lifelong reminders of carrying a child. Genetics, health status, pregnancy course and delivery mode affect the type and extent of lasting changes. A healthy lifestyle with diet, exercise and self-care helps maximize the body’s potential to recover postpartum. Seeking timely treatment for any pregnancy-induced issues also prevents them from becoming permanent.