Management of Lower Extremity Edema During Pregnancy
Management of Lower Extremity Edema During Pregnancy
Pregnancy is one of life’s most exhilarating and precious journeys! However, like everything in life, there can be moments where this new adventure may present with difficult days as well. You may notice that you tend to feel more fatigued as your body works overtime to support your growing baby. Pregnancy can make simple daily activities such as walking, sitting, standing and the like feel quite uncomfortable due to constant pressure from the new baby weight leading to swelling in your legs and feet. Why does this happen?
Lower extremity edema (feet swelling), not associated with preeclampsia, is present in about 80% of all pregnancies. During late pregnancy, healthy women without any prior history of venous disease often present with gestational edema. Extremity edema involves the accumulation of extravascular interstitial fluid and is influenced by a variety of factors. The etiology may be hormonal or mechanical in origin. What are these factors?
The hormonal factor is due to estrogen and progesterone induced increase in venous volume and vein wall distensibility. This contributes to that coveted “pregnancy glow.” During pregnancy, the body produces approximately 50% more blood and body fluids to meet the needs of the developing baby. The extra fluids account for approximately 25% of the weight women gain during pregnancy. The second factor, mechanical in nature, is caused by the caval compression generated by the enlarged uterus. Nevertheless, do not fret. The good news is that gestational edema normally resolves on its own in the postpartum period.
However, in the interim, here are little tips and pearls for management of gestational edema. Consider the following:
- Intermittently lying on the left side (this will help remove the uterus off the inferior vena cava)
- Elevating bilateral lower extremity (putting your feet on a low stool for example will help take pressure off your back and reduce blood pooling in your legs and feet) and avoid standing for long periods of time
- Wearing elastic compression socks or stockings (grade 1 pressure range from 10 to 20mmHg can stimulate a decrease in the risk of developing lower limb edema, diagnosed venous insufficiency will require grade 2 pressure of 20-30 mmHg or greater)
- Wearing loose clothing that does not restrict blood flow, especially in the legs
- Wear comfortable shoes, avoid high heels when possible
- Minimize sodium (salt) intake, eat foods rich in potassium (bananas), and limit caffeine
- Drink water which will help flush the body and reduce retention
- Regular exercise with gentle flexion of the foot to stretch the calf muscles is also advised and has been shown to help (make sure to clear all activity with your OB-GYN first)
Finally, congratulations on your pregnancy! Be sure to enjoy this amazing new adventure and take it one step at a time.
- Chaar CI. Current Management of Venous Diseases. Springer; 2017.
- Gardenghi LA, Dezotti NR, Dalio MB, Joviliano EE, Piccinato CE. Gestational lower limb edema and venous reflux in healthy primigravidae. Int Angiol. 2017;36(6):569-573.
- Ochalek K, Pacyga K, Curyło M, Frydrych-szymonik A, Szygula Z. Risk Factors Related to Lower Limb Edema, Compression, and Physical Activity During Pregnancy: A Retrospective Study. Lymphat Res Biol. 2017;15(2):166-171.
- Swamy GK, Heine RP. Lower-Extremity Edema During Late Pregnancy. Content last modified 2018. Merck Manual [database online]. Whitehouse Station, N.J.:Merck Sharp & Dohme Corp.; 2012. Accessed May 4, 2020.
- Wick MJ. Mayo Clinic Guide to a Healthy Pregnancy, 2nd Edition: Fully Revised and Updated. Mayo Clinic; 2018.
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