Is she pregnant?

Dear doctor: My new wife is light-skinned. I have never seen her using any skin oil but I have noticed her feet and fingers getting black spots. She also complains of constipation. Is she taking pills or she is deceiving yet she came while pregnant?
- Jim Batuma

Dear Jim: Although many women who take contraceptives may have no side effects, a few may be plagued by nausea, constipation, on and off bleeding and patchy darkening of skin (mealasma). This is called mask of pregnancy.
The hormonal changes, accompanying both pregnancy and oral contraceptive use are usually to blame. This can affect any part of the body but is generally found on sun-exposed areas of the face, and other generally darker areas like below the belly button and around the breasts. Mealasma often fades over several months after stopping oral contraceptives, but may return on resumption of contraceptives. In some people, the hated darkening never entirely disappears.