Second Trimester Pregnancy & Symptoms: The Ultimate Guide

Second Trimester Pregnancy & Symptoms - image

The second trimester of pregnancy starts as you enter week 14 and runs through the end of pregnancy’s 27th week. The second trimester is the most comfortable for many women. The morning sickness and extreme fatigue of the first trimester have usually improved or even subsided by this point. And the aches and pains of late pregnancy have not yet begun. You will likely feel pretty good this trimester, and really get to enjoy some of the cool experiences of growing another life!

If you haven’t read up on pregnancy to this point, check out Kopa Birth’s First Trimester Pregnancy & Symptoms: The Ultimate Guide. Then dive on in to learn all about the second trimester!

Estimated reading time: 24 minutes

Changes in Baby in the Second Trimester of Pregnancy

By the end of this trimester, baby looks fully like a “real person,” though very small. Incredibly, with the medical advancements we’ve made in recent decades, babies born at the end of the second trimester are likely to survive, and over half will do so without major impairments. (But let’s work hard to keep baby safely inside for as long as possible! It’s a long, hard road for preemies, and even those who are free of “major impairments” often struggle with more complications that their peers.) Still, it’s exciting to think of how well developed your little one is by the end of this trimester. Let’s take a look.

As you enter the second trimester of your pregnancy, your baby is around the size of a lemon. He or she is about 3 ½ inches long (measured from crown to rump) and weighs around one ounce. By the middle of the trimester, he has even tiny details like eyebrows and eyelashes. And by the end of the trimester, he has grown to around two whole pounds! He is now blinking his little eyelids and is able to sense bright light. And his heart rate may decrease at the sound of familiar voices, suggesting that he is calmed by your voice (1).

You enter the second trimester unable to feel baby’s movements, but usually feel the first flutters between weeks 16 and 22. By the end of the trimester, you’re used to feeling regular movement that gets stronger all the time, and there’s a good chance your partner and others may be able to feel the kicks as well.

Changes in Mom in the Second Trimester of Pregnancy

Weight Gain

In your second trimester, you’ll start to gain weight more quickly as your baby grows and your blood volume and amniotic fluid increase. You may gain, on average, around a pound a week. Women who were overweight or obese before pregnancy might gain more like ½ pound a week. Talk to your doctor about your specific situation.

Learn more: How Much Weight to Gain During Pregnancy

Baby Bump

While you may enter the second trimester of pregnancy still looking much like your old self, you’ll finish it with quite a baby bump. You’ll likely find that maternity clothes become your most comfortable option. And your little one will remind you of his or her presence with the sweetest little flutters

Midway through this trimester, your doctor will begin measuring your fundal height, a measurement that helps track your baby’s growth. By the middle of your pregnancy, the distance from your pubic bone to the top of your uterus (in centimeters) should approximately equal your baby’s gestational age. For example, if you’re 25 weeks pregnant, your fundal height should be about 23 – 27 centimeters.

Second Trimester Pregnancy Symptoms

Stretch Marks

For many women, the second trimester of pregnancy is when they begin to develop stretch marks. These red, purple, or reddish-brown streaks appear when your skin stretches because of damage to the supportive elastic tissue beneath the skin. You can’t prevent this damage; it seems that some people are simply more prone to them than others. And while you can’t get rid of them once they’re there, they will fade over time to a lighter silvery color that is much less noticeable. If it makes you feel better to do something other than just watch them appear, keep your skin hydrated with a good moisturizer and by drinking plenty of water.

Heartburn and GERD

Heartburn, or acid reflux, is one of the pregnancy symptoms that may persist throughout your pregnancy. (GERD, gastroesophageal reflux disease, is acid reflux that happens more often – mild reflux at least twice a week or more severe reflux at least once a week.) Heartburn occurs when acid from your stomach comes up into the esophagus, the tube that connects your mouth to your stomach. There is a valve that usually prevents food and acid from moving in the wrong direction, but there are a couple of reasons why reflux happens in pregnancy.

First, progesterone relaxes the muscles in your body during pregnancy. This slows down the entire digestive process in your body, and can also affect the valve that is supposed to keep food and acid in your stomach. The other factor is that as your baby grows and your abdomen gets crowded, there’s increased pressure on your stomach that can contribute to its contents being pushed back up. For tips on managing heartburn and GERD, check out our article Banish the Burn! GERD During Pregnancy.


As we discussed in our first trimester article, anemia is not uncommon in pregnancy. As your blood volume increases, your body needs more iron and vitamins to make hemoglobin, which carries oxygen to your cells. Anemia is when your body doesn’t have enough hemoglobin and therefore you’re not getting the optimal amount of oxygen, which can be damaging to your body or your baby’s. Fortunately, most cases of anemia are mild, and there’s treatment for even severe anemia. Treatment starts with an iron-rich diet – lean beef and pork, leafy greens, liver and other organ meats, dried fruit, beans, whole grains, nuts – then moves on to supplements if needed, and can even mean IV infusions if the other options haven’t worked.

Back Pain

In the second and third trimesters of your pregnancy, you very well may find that your back hurts by end of the day. This is caused by a combination of factors. Hormones relax all of your joints. Your growing bump stretches out and weakens your abdominal muscles, meaning that your back has to overcompensate. And your bump shifts your center of gravity and changes your posture. Some things you can do to help: maintain good posture; stay active and continue exercising; don’t bend at the waist (squat if you need to lift something); wear low shoes rather than heels; use a pregnancy belt or abdominal support garment.

One of the best ways to help with back pain is to keep your core muscles strong. Here are some Safe Core Exercises During Pregnancy.

Sleep Difficulties

Between 65% and 95% of pregnant women report sleep changes (2). Your body may be uncomfortable, your mind may be full of thoughts or even concerns about coming life changes, and your bladder may wake you more frequently. Here are some tips on getting a restful night’s sleep:

  • go to bed and wake up at the same time each day
  • “screens” (tv and phone) off at least an hour before bed
  • exercise regularly
  • keep your bedroom dark and cool

It’s also time to switch to a side-sleeping position; you won’t be able to comfortably sleep on your stomach, and sleeping on your back causes your uterus to put pressure on a major blood vessel that supplies blood to your baby.

Vivid Dreams

Vivid dreams are among the odd symptoms that you may not know that pregnancy can bring. Most researchers agree that dreams are your subconscious mind’s way of working through your feelings and the events in your life. Dreams may be your mind’s way of coping with the significant changes and unique stresses that come along with pregnancy, and this may result in more vivid, emotional dreams and even nightmares.

Feet Growing

This may seem like a really odd symptom. After all, you stopped growing years ago! A couple of things may contribute to your ever-tightening shoes. Water retention, swelling, and overall weight gain may be a factor. And the hormone relaxin, which causes joints throughout your body to loosen, also loosens the ligaments in your feet, causing the foot bones to spread. You can try elevating your feet to help with swelling, but if the problem seems to be a matter of bones spreading, there’s not much to be done besides shopping for new shoes. Foot changes of this type are often permanent, even after your baby is born.

Leg Muscle Cramps

For some women, leg cramps increase during pregnancy, and they happen most frequently at night. When a muscle spasm occurs, the best way is to get relief is to stretch the muscle. You can have someone else push on the bottom of your foot, to bring your toes toward your shin and stretch that muscle. Or, the quickest way to relieve the pain is usually to just stand up. Standing on the leg that’s cramping usually provides quick relief.

Varicose Veins

Varicose veins are swollen, bulging veins caused by a weakening of the walls of your veins. They happen more frequently in pregnancy because progesterone makes the walls of the veins relax, you have an increased volume of blood, and your growing uterus puts pressure on the veins in your legs and makes it more difficult for the blood to flow back upward. It can be just a cosmetic issue, but some women experience painful or itchy bulging veins. The best ways to help are: avoid standing for long periods; elevate your feet as much as possible; and wear support hose.


Hemorrhoids are swollen and inflamed veins around your anus or in your lower rectum. They’re common during pregnancy, possibly because of the uterus pressing on the veins and interfering with circulation combined with the straining that accompanies constipation (which is also common in pregnancy.) Hemorrhoids can cause itching, swelling, pain, and bleeding. Here are some things that may bring relief: drink a lot of water and eat plenty of fiber, which can reduce constipation; rest with your feet and hips elevated for at least an hour a day; apply cold compresses or cotton balls soaked in witch hazel to the anus; don’t sit or stand for long periods, which can allow blood to pool in hemorrhoids.

Urinary Tract Infections

Urinary tract infections (UTIs) are infections of the bladder, kidney, or urethra. They’re more common in pregnancy, partly because the weight of the uterus can press on the bladder and prevent it from completely emptying. Your doctor can detect a UTI with a simple urine test and treat it with an oral medication. Call your doctor if you have any UTI symptoms:

  • pain or burning when you urinate
  • foul-smelling urine
  • an urgent need to urinate
  • needing to go frequently but only passing small amounts of urine
  • cloudy urine, with or without blood in it
  • fever
  • back pain

Vaginal Infections

Vaginal infections are more common in pregnancy, possibly because of hormone changes. The vagina has good, normal bacteria that helps keep your birth canal healthy. But sometimes the balance can get off, and there can be an overgrowth of bacteria. You may have an infection if your vaginal discharge has changed from its normal color and is gray or milky, has a bad, fishy odor, or is accompanied by vaginal pain, soreness, or itching. Let your doctor know if you have any of these symptoms. Bacterial vaginosis can be treated with a simple course of antibiotics.

Dental Changes

Pregnancy affects so many different parts of your body, some of which may surprise you. You may notice that your gums swell and bleed. This is due to pregnancy hormones and increased blood volume in your body. Don’t take a break from brushing, though. Keep up with your hygiene so that there aren’t problems later, and don’t worry if you see a little pink on your toothbrush or in the sink.

Pelvic Bone Pain

In the second and third trimesters, some pregnant women experience sharp, shooting pains near their pubic bone. It tends to be worse with activities that cause you to lift one leg at a time, like walking and climbing stairs. The pain is likely coming from the pubic symphysis – a joint that connects the right and left halves of your pelvis. Like the rest of your joints, it becomes more mobile in pregnancy when the hormone relaxin loosens up joints. It may help to avoid standing for long periods of time, wear a pregnancy belt during the day, and sleep with a pillow between your legs at night.

Tiredness and Fatigue

Many women find that they’re less fatigued in the second trimester of their pregnancy than they were in the first. This is a nice reprieve before fatigue returns in the third trimester. If you have more energy now, enjoy spending it on some projects around the house, extra time with friends or family, or enjoying your hobbies. If you find that you are still fatigued, follow the advice we gave in our first trimester article: exercise for 30 minutes most days of the week, eat a healthy diet where you focus on pairing protein and complex carbohydrates in each meal and snack, drink plenty of water, and fit in extra rest when you’re able.

Hot Flashes

Many women feel hot during pregnancy. Your metabolism increases, and this increase in calorie burning generates heat. In addition to an overall feeling of being warm, you may have hot flashes. This is likely due to fluctuating hormones like estrogen – the same reason hot flashes happen in menopause. Stay cool by dressing comfortably and drinking plenty of ice water.

Stuffy Nose and Nosebleeds

Not even your nose is immune to pregnancy symptoms! Elevated estrogen levels in pregnancy cause an increase of blood flow to all of your mucous membranes. This can mean swollen mucosal tissue and nasal congestion. And having to blow that stuffy nose all the time may lead to nosebleeds as well. You can’t take antihistamines or decongestants during pregnancy. However, you can ask your provider about using a saline spray and you can try running a cool-air vaporizer during the night. If none of this helps, just know that the congestion will clear up after your little one is born.

Gestational Diabetes

Most people are familiar with diabetes, a problem with the way a body regulates glucose (sugar.) Gestational diabetes mellitus (GDM) is when a woman who didn’t already have diabetes develops it during pregnancy, and it occurs in about 10% of pregnancies (3). A screening is done on all pregnant women in the second trimester of pregnancy, because it can develop in anyone. However, you are at higher risk for developing gestational diabetes if you: are overweight or obese; had gestational diabetes in a previous pregnancy; previously had a baby who weighed nine pounds or more at birth; have high blood pressure; have heart disease; are physically inactive; have PCOS, or have a parent or sibling with diabetes.

Gestational diabetes does increase risks for both mom and baby, but today most women with gestational diabetes have healthy pregnancies and babies. It is important that you work with your caregiver and follow your treatment plan to keep your blood sugar levels stable. You will first work with a doctor and possibly a dietician to modify your diet and activity level. If your levels are still too high, you may be prescribed insulin to manage your glucose levels. Go more in depth: Gestational Diabetes: Causes, Risks, and Treatment.


Many women will tell you that during pregnancy they experienced forgetfulness, difficulty focusing, and brain fog. And some studies have backed it up (4). How can you combat pregnancy brain? Make sure you’re sleeping enough, eating well, and getting regular exercise. Beyond that, set reminders and live by a written or digital schedule for now, since your brain may find it harder to remember everything. (As a sleep-deprived mom of a newborn, you’ll be glad that you developed the habit of living by a planner or reminders on your phone.)

Depression and Anxiety

For the most part, each Kopa Birth trimester-specific Ultimate Guide presents new information that is relevant to the current trimester. However, this is so important that we want to repeat what we said in the first trimester guide.

Beyond the regular pregnancy mood swings – fleeting emotions that come and go – some women experience excessive depression and/or anxiety in pregnancy. Again, this is absolutely normal. Some women feel guilty if they’re not 100% happy all the time when pregnant. But feeling sad or anxious does not mean that you’re not excited about your pregnancy or that you’re not feeling the way a pregnant woman “should.” Pregnancy brings huge life changes, and while they may feel exciting, they may also (even at the same time) feel overwhelming, scary, and stressful. You may worry about your health or that of your baby, about the financial impact of a new baby, about how your relationships will change, about what kind of parent you’ll be.

Not only are you not alone, you’d probably find that nearly every pregnant woman would tell you she’s had the same emotions. And even if you are struggling a bit more than it seems some other people might be, it’s still not uncommon. 20 – 25% of the overall population struggles with mental health challenges (most commonly, depression and/or anxiety), so it makes sense that you’d see similar numbers in the pregnant population. Perhaps even more, since it’s such a stressful time in your life. Talk to your doctor if you’re struggling. I assure you that they hear it often and won’t be surprised or put off by it.

To Do

Continue Exercising

Your shape is changing and you may tire more easily than before pregnancy, but some women actually find that they have a bit more energy in the second trimester than they did in the first. Either way, it’s important that you stay healthy by continuing to get 30 minutes of exercise most days. This will help you stay strong through your pregnancy, have the strength and energy required for childbirth, and bounce back more easily after your baby is born.

Eat Healthy Foods

Focus on nourishing foods that will give you enough energy and support your developing little one. An occasional treat is okay, but make sure it’s just on occasion. And remember that you’re not really “eating for two.” You need to consume an extra 300 – 350 calories a day in the second trimester, but it’s easier to hit that amount than you might think, so it may be helpful to track your calories during pregnancy rather than just eating extra without any guidance. Continue to focus the bulk of your diet on whole, unprocessed foods – lean protein, whole grains, and fruits and vegetables.

Drink Plenty of Water

Continue to aim for 8 to 12 glasses of water a day, or 64 to 96 ounces. Staying hydrated can help combat headaches, nausea, constipation, and UTIs. And you need lots of water to continue to create new blood cells and amniotic fluid, carry nutrients to your baby, and remove toxins and waste (yours and baby’s) from your body.

Build a Maternity Wardrobe

You may enter the second trimester of your pregnancy wearing your regular clothes, but your changing shape will mean that it’s time to shop for maternity clothes before you know it. At first, you can hang out in comfy leggings and sweats with oversized tees or sweatshirts. But you’ll likely need at least a handful of maternity items. If it’s fun for you, and your budget allows, feel free to build a whole little wardrobe. But it doesn’t have to be expensive or stressful. Because maternity clothes are worn for such a short time, it’s often easy to find good-quality stuff at second-hand stores. Or your family or friend groups may pass things around to each other.

There’s so much variety out there these days that you can probably find maternity clothes in whatever styles you prefer. If the idea of ruffles and bows seems awful to you, know that maternity jeans and band tees are out there for you. Also, as you shop, keep in mind that some maternity items are made to double as nursing wear later. If you plan to breastfeed, keep your eye out for things that can do double duty.

Announce Your Pregnancy

If you haven’t told already, this trimester will be the time when you can no longer camouflage your pregnancy. It is up to you when and how to tell family, friends, and your employer that you’re expecting. There is no right or wrong way to do so; just do whatever feels most natural to you. If you’re the type who enjoys surprises and big announcements, then by all means, suprise siblings-to-be, grandparents-to-be, and others in fun ways. If that sounds like a nightmare to you, then there’s absolutely nothing wrong with just having a low-key conversation where you let others know that your family is growing.

The one thing you may want to keep in mind is whether or not there are people in your circle who have struggled with infertility, pregnancy loss, or other things that might make your announcement difficult. It is most sensitive to tell these people privately and gently before they hear a big announcement or hear if through the grapevine.

Go to the Dentist

It is recommended that you visit your dentist at least once during pregnancy. The American Dental Association and American College of Obstetricians and Gynecologists agree that routine dental care is safe. And while it’s often recommended that dental work be postponed in early pregnancy, until after the first trimester, you’re now in a place where you can go ahead with needed work. Just make sure your dentist knows you’re pregnant.

Think About Doulas

If you’re thinking about hiring a doula, now is the time to interview them. If you don’t know much about doulas, this is a great time to do some research and talk to your partner about whether or not it’s something you want. Doulas support both parents, bring a wealth of knowledge and experience to labor and childbirth, can help you use your voice in high-stress or fast-moving situations, lead to better birth outcomes and more satisfied moms, and function as an extra member of your support team. If your budget allows, and you feel like you’d be comfortable adding another person to your birth circle, consider hiring a doula.

Look Into Childbirth Class Options

The end of the second trimester of pregnancy is the ideal time to start taking childbirth classes or to find one if you haven’t already. The goal is to finish your natural childbirth class at least one full month before your due date, and two months is even better. Many classes run for four weeks, so if you can start by week 28, you can finish up at around week 32, and have two months to practice your breathing techniques, relaxation, and other labor coping tools.  


Consider a “babymoon” or some special time with your partner before baby comes – The second trimester is often thought of as the easiest time of pregnancy, a time when many pregnant women feel relatively well. By the time the third trimester hits, you may have less energy or an achy body, or you may just feel a little less comfortable traveling later in pregnancy in case your little one makes an early entrance. Some couples like to take a “babymoon” to spend some one-on-one time together before life changes with the birth of your baby.

Look Into Childcare

If you’re planning to go back to work, start thinking about where baby will be when you’re working. Some couples work opposite schedules so that one of them can be with the baby at all times. Some are fortunate to have a grandparent or someone close who can keep the baby full time. But for most families, two working parents means that the little one will need childcare. This may be in a daycare center, a home daycare, or with a private nanny or babysitter. Spend some time looking at each option, going over your budget, and interviewing potential caregivers.

Think About Baby Names

You still have time, but if you haven’t already, start kicking around baby names. This is a part of pregnancy that many parents-to-be find fun. Take a look through your family trees, characters from stories you love, or just lists of names. It may be fun to each make a list and see if any names appear on both lists. However you approach naming, remember that you’ll probably be happiest if you spend some time sitting with the name possibility for some time before committing.

To Avoid

These things to avoid remain the same throughout pregnancy, as they are unsafe for your baby at any stage of development.

Smoking (this includes vaping and all forms of smoking) and drinking alcohol.

Taking any illegal drugs or any over-the-counter or prescription medications that were not specifically prescribed for you during this pregnancy and discussed with your doctor.

Certain foods that are more likely to carry bacteria and toxins that could make you sick or harm your baby. This includes raw sushi, cold cuts, raw eggs, unpasteurized dairy, and unwashed produce.

Hot tubs, saunas, and hot baths or showers. When your body temperature rises, so does your baby’s, but his or her temp takes much longer to come down. The prolonged rise in temp could cause baby to develop neurological disorders like seizures.

Scooping cat litter. Have someone else do it if possible, and wear gloves if you must do it. Cat feces may contain a parasite that causes toxoplasmosis.

Gardening without gloves. Toxoplasmosis may also be present in soil, so you shouldn’t garden with bare hands while pregnant.

Spray painting, because of the possibility of inhaling paint particles or chemicals. And if you do paint, it’s best to use low-VOC or no-VOC paints, wear gloves, and make sure there’s plenty of ventilation.

Doctor Visits in the Second Trimester of Pregnancy

Most of the things you can expect at your second trimester doctor appointments are things you’ve already experienced at your first trimester appointments. You’ll weigh in, and have your blood pressure checked. You’ll give a urine sample to check for protein (which can suggest high blood pressure or preeclampsia;) sugar (which could mean gestational diabetes;) and bacteria (which could mean a urinary tract infection.) You will be asked questions such as what symptoms you’ve been feeling, whether or not you’ve felt the baby move (and later, whether or not the baby is moving as often as usual,) if you’ve had any bleeding or noticed any leaking fluid, if you have felt any contractions. Your doctor will listen to baby’s heartbeat and after about the 24th week, he or she will also measure your belly.

Learn More: Second Trimester Appointments: What to Expect


At one of your second trimester appointments, typically between Week 18 and Week 22, you’ll have an ultrasound. This will tell your doctor how your baby is developing; whether there are any visible abnormalities; where your placenta is attached and whether it looks healthy; how much amniotic fluid is in your uterus; how many babies you’re carrying and what position they’re in; and whether it seems that your estimated due date is accurate. And of course, while they’re looking at baby, you may be able to find out gender if you choose to.

Finding Out Gender

One thing that many parents look forward to is the ultrasound where they can find out baby’s gender. While this second trimester ultrasound provides your doctor with all of the information listed above, it’s the gender reveal aspect that has parents excitedly counting down to ultrasound day. Some parents choose not to find out, wanting to be surprised in the delivery room when baby is born. But for many parents, there’s a thrill in learning a piece of information about who your baby might be midway through the pregnancy, since you’ve still got the big surprise of meeting them in the delivery room.

Glucose Screening

Between Week 24 and Week 28 of pregnancy, you will have a glucose screening to check for high levels of glucose that may indicate gestational diabetes. You’ll drink a sugary drink that tastes a bit like flat orange soda, wait for an hour, and then they’ll take a blood sample. This lets them know if your body is able to get your blood glucose level back down to an acceptable level within that hour. If the numbers are higher than 140 mg/dL, you’ll need to come back for a more in-depth three-hour test.

Second Trimester Screening Tests

Early in the second trimester, you will be offered other screenings that check for the possibility of things like genetic disorders, chromosomal abnormalities, and neural tube defects. Finding these things early can give parents time to prepare for a child with special healthcare needs. These screenings – the Alpha-fetoprotein (AFP) test, Triple screen test, and Quad screen test – don’t diagnose any condition, but they give a heads-up that there may be a problem so that further testing can be done.

The March of Dimes has an excellent resource on Prenatal Tests if you’d like to learn more.

Call Your Doctor Immediately

If you have any of the following symptoms, call your doctor or midwife right away:

  • bleeding
  • painful cramping/severe abdominal pain
  • severe diarrhea
  • severe vomiting
  • high fever
  • dizziness
  • pain when urinating or trouble urinating
  • severe headache
  • sudden swelling of hands/face
  • vision disturbances

Kopa Birth’s online childbirth classes allow you to prepare for a natural childbirth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class to learn more about preparing for a natural hospital birth.


  1. The American College of Obstetricians and Gynecologists.  (2010).  Your Pregnancy and Childbirth Month to Month, 5th edition.
  2. Glade, B.C., Schuler, J.  (2011).  Your Pregnancy Week by Week, 7th edition.  First Da Capo Press
  3. Gestational diabetes. (n.d.).
  4. Davies, S. J., Lum, J. A. G., Skouteris, H., Byrne, L. K., & Hayden, M. J. (2018). Cognitive impairment during pregnancy: a meta‐analysis. Medical Journal of Australia, 208(1), 35–40.
  5. Simkin, Penny, et al. Pregnancy, Childbirth, and the Newborn: the Complete Guide. Da Capo Lifelong, 2018.

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Meet Katie Griffin

I’m a registered nurse, Lamaze certified childbirth educator, and the mother of 7. I help women realize their dream of a natural, intimate, and empowering hospital birth.

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The second trimester of pregnancy starts as you enter week 14 and runs through the end of pregnancy’s 27th week. The second trimester is the most comfortable for many women.