Things they said would happen during pregnancy: morning sickness, big tummy, food cravings. One thing they may not have mentioned: Huge changes to your circulatory system.
During the nine-month period, your entire vascular system gears up to deliver oxygen and blood to both you and the growing baby. Your body creates 50 percent more blood and your heart works 30 percent harder. Along the way, new chemicals and hormones begin to circulate in the blood. And the bigger the baby gets, the more it pushes against the blood vessels that serve the legs and back.
These changes can cause vascular issues that are extremely common during pregnancy and in most cases they are just annoying, vascular surgeons say. Occasionally, however, there are complications that will need immediate attention. Here are some things you should know as you progress in your pregnancy:
- VENOUS INSUFFICIENCY. Up to 80 percent of pregnant women get some kind of venous insufficiency, which means that, though blood can flow down into the feet, it may have trouble getting back up to the heart. Women with venous insufficiency notice leg swelling and pain, night cramps, numbness and itching.
Sometimes the valves in the veins are weak and sometimes there is an anatomical reason that is aggravated by the extra blood, as well as by the baby that has parked itself on your inferior vena cava. In any of those cases, blood can pool in the legs and feet, causing swelling and pain.
Most of the time this starts in the first trimester and with subsequent pregnancies it can become worse. Risks increase for those who are smokers, who have a family history of vein problems or blood clots, or who are obese.
What to do:
Elevate. Put your feet up whenever you can. Any swelling you get during the day should be gone after a night’s sleep. If not, tell your doctor.
Wear compression stockings. They may not be your favorite fashion statement, but they are proven effective at improving leg symptoms during pregnancy and preventing complications afterwards.
Vascular researcher Dr. Caitlin Hicks, a senior fellow at Johns Hopkins Hospital, says compression stockings should be worn by all pregnant women who have leg heaviness, leg cramps or swelling in the legs and feet. Dr. Hicks was the lead author of a review of pregnancy’s vascular effects in the February edition of the Journal of Vascular Surgery Venous and Lymphatic Disorders.
- VARICOSE VEINS. Women who notice these changes during pregnancy are 40 percent more likely to develop varicose veins. Some may be treated with medication to prevent additional complications. Those complications can include vein inflammation and superficial or deep vein blood clots.
What to do:
Tell your ob-gyn if your feet are swollen and red when you get up in the morning, or if you have swelling, pain or redness along a vein. Be sure to alert the doctor if one leg or foot is swollen and painful and the other is not. You may be referred to a vascular surgeon. Vascular surgeons treat disorders in the circulatory system with medication and sometimes surgery.
If you need medication during pregnancy your doctor will prescribe one that will not affect the baby. Nonsteroidal anti-inflammatory drugs and low-molecular-weight heparin are two that can be safely taken during pregnancy.
- BLOOD CLOTS. In a few cases, the mother develops a blood clot that travels through the vein from the leg up into the lungs. If this happens, you will become very short of breath.
What to do:
Tell your doctor if you are short of breath. Usually shortness of breath is just a symptom of having an enormous baby playing kickball in your uterus, but it is worth mentioning to your ob-gyn.
In a perfect world, every doctor would catch every abnormality, however, “it is always a good idea to advocate for yourself,” said Dr. Hicks. “You can just say, ‘It hurts to breathe,’ or ‘would you mind looking at my legs?'”
- ASK BEFORE YOU FLY. You may have heard this but it is worth repeating: If you are thinking of making travel plans, ask your doctor if it’s OK to fly. Particularly if you are having any venous issues, it is wise to get cleared for air travel.
What to do: Wear compression stockings on your flight.
- IT’S NOT OVER TILL IT’S OVER. Don’t assume that once your baby is born you’re off the hook. In most cases, the volume of blood, heart effort and vein dilation all return quickly to normal. But some mothers get chronic venous dilation from pregnancy that doesn’t fully resolve.
What to do:
Pay attention to your health after the birth. This can be difficult when all your attention is on the baby, who may be opting for a 30-minute feeding cycle. Moms with chronic venous dilation are at higher risk for a variety of vascular problems, and you don’t want to be laid up when you’re busy being a new mother. Symptoms will include leg swelling, rashes, pain in the legs or changes in skin color.
Most leg vein symptoms in pregnancy are not serious and go away after the birth. However, if you have marked swelling in one leg, or have swelling and become short of breath, you should immediately let your ob-gyn know.
At this point, said Dr. Hicks, “you likely will be referred to a vascular surgeon. He or she can make sure you do everything you can to get your body back into excellent health.”