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Pregnancy Swelling: Not So Swell

When pregnant, you obviously expect your stomach to get bigger. To see your feet and ankles increasing in size, however, might be a surprise.

Reasons for Swelling

“In fact, the most common reason for swelling is ‘normal response to pregnancy’ in the absence of other serious conditions,” says Dr. Robert Silver, associate professor of obstetrics and gynecology at the University of Utah. “This is due to an increase in the total amount of body fluid and a lower concentration of protein to keep the fluid in the blood vessels.”

Swelling can also lead to noticeable discomfort. Angela Drinkwater of Greenport, New York, experienced this in her fourth or fifth month of pregnancy. It started with her ankles. If she crossed them for even a second, she’d have a major imprint. It made her uncomfortable. “I ended up like the blueberry girl in Willie Wonka toward the end,” says Drinkwater.

Types of Swelling

“Lower extremity swelling that is ‘normal’ tends to worsen during the course of the day, especially with ambulation [movement],” says Dr. Silver. It gets better when feet are elevated. Swelling due to disease, however, usually persists, even after elevating the feet.

Usually, no adverse consequences occur due to swelling. It might cause discomfort, but most women should be reassured, says Dr. Silver. There may be a theoretical increase in the risk for blood clot, but this is unproven, he says.

There are several types of swelling that are not normal. Preeclampsia is one of the more common diseases that causes swelling, along with kidney disease. Less common is heart failure or lymphedema. Swelling that is asymmetric may be due to blood clots—either new clots or residual damage from old ones, says Dr. Silver.

Pregnant with her third child, Michelle Knoll is starting to swell up for the third time. It seems like a lot earlier this time, however—she’s only 22 weeks pregnant. The swelling is mostly in her ankles and feet and goes away during the night and progressively gets worse over the course of the day. Some days—like hot ones—are worse than others.

“It’s more uncomfortable than anything else,” says Knoll, who is from Lakeville, Minnesota. “Your legs and feet start to feel real tight. Shoes don’t fit or feel comfortable anymore, and like with any pregnancy-related issue, it just makes you a little more nervous about other problems like toxemia, preeclampsia, etc.”

Knoll recently saw her doctor for the swelling. “All they ever tell me is drink lots of water, watch your sodium intake, don’t sit too long, and put your feet up when you are sitting,” says Knoll. “All this only helps to a point. I’ve decided it all depends on the weather and of course how big the baby is getting. Humidity is a killer.”

Standing too long can cause swelling, says Dr. William Rayburn, Seligman professor and chair of the Department of Obstetrics and Gynecology at the University of New Mexico. Unfortunately, swelling can’t really be prevented completely. A nutritious diet that isn’t high in sodium might help.

Managing Fluid Retention

Swelling can be managed by “lying down, especially on the side, and by treatment of any underlying medical conditions,” says Dr. Rayburn. “Fluid pills are to be discouraged.” Elevating the legs above the heart may be more ideal, but is impractical, he adds.

Tight support hose are also effective, says Dr. Silver, but of course this is more practical in the winter than the summer. Women are often told to drink a lot of water, he says, but this doesn’t help. Dr. Rayburn concurs, but adds that it’s beneficial in very hot weather.

As a physician, when does Dr. Rayburn get concerned about swelling during pregnancy? “Either when it becomes so excessive that it impairs her bodily functions (difficulty urinating, less blood flow to affected areas) or that the underlying medical condition is worsening,” he says. “A common finding is for the mother-to-be to be unable to take off her rings. We rarely do anything about this unless there is impaired circulation.” He doesn’t think he’s ever seen rings have to be removed.

Dr. Silver says there’s no threshold or amount of swelling that causes him concern. If the physician has excluded serious medical problems, he says the patient can be reassured.

The Waiting Game

Unfortunately, the situation typically does not resolve very quickly after giving birth. “Swelling of the feet and ankles normally persists for days—usually up to two weeks—after delivery,” says Dr. Rayburn.

This might be discouraging, but after nine months, you can wait another week or so before you slip on those tight-fitting fancy shoes. Besides, they won’t be very suitable for those 3 AM feedings anyway.

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