Swollen Feet

INFORMATION FOR WOMEN WHO HAVE SWOLLEN FEET DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What are swollen feet during pregnancy?

Pregnancy produces a variety of changes in physiology, hormones, and body structure, all of which contribute to slowing the movement of fluids in the lower extremities. This can lead to swelling (edema) in the legs and feet, which is often the result of varicose veins. Varicose veins are superficial veins that have become enlarged, twisted, and swollen due to blood flowing back through valves that have evolved to keep blood running in one direction, toward the heart, which in the case of your legs or lower torso means upward against the direction of gravity. Hormonal changes during pregnancy make the walls of your veins more flexible than usual, while the growing womb puts pressure on deep veins in your pelvis. Since deep veins are connected with superficial veins through a system of short connecting veins, a backflow of blood can develop, resisting the upward flow of blood through superficial veins in your legs. Typically, this happens in a great saphenous vein, the longest in the body, running along your leg, but it also can happen on the superficial veins of the torso.

How common are swollen feet during pregnancy?

Studies in the medical literature reported the prevalence of varicose veins ranging widely from just above 1 percent of pregnant women to as high as 73 percent of women overall, including those who pregnant. The risk of developing varicose veins increases in people whose occupation keeps them standing without walking around for long periods of time. Teachers fall into this category, as do surgeons. Simply the presence of swollen feet, with or without varicose veins is very common in pregnancy, especially during the last five weeks of pregnancy.

How are swollen feet diagnosed?

Diagnosis begins with a review of your medical history and a physical examination. Your doctor will examine your legs and feet and measure the swelling (edema) in terms of qualities such as how far the skin can be pushed in. Veins will be checked by looking to see that they are swollen and that they remain swollen if you continue standing up. Various other tests, such as ultrasonography, may be ordered to assess underlying conditions, particularly problems with venous blood flow, including varicose veins, which will be graded for severity. This is done by means of whats called the Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) score, which runs from C0 to C6, depending on your symptoms, the appearance of the veins, the amount of swelling, skin damage, and the presence or absence of ulcers (sores). While C0 means that there are no varicose veins and C6 means there is a venous ulcer, C1-C5 grades indicate various levels of severity in between. Distinctions between higher grades (C4-C6) has implications as to whether or not you could be in danger, while distinctions between lower grades (C0-C3) is typically relevant to whether your health insurance will cover treatment, or which treatment will be covered. In addition to the physical examination, the main procedure for diagnosing your venous system is called duplex ultrasound.

Do swollen feet cause problems during pregnancy?

Yes. Swollen feet can be painful and otherwise uncomfortable, especially as your belly size increases throughout pregnancy. As for varicose veins that are associated with swollen feet, a CEAP score of 2 or lower generally means that your varicose veins are a cosmetic issue. From C3 upward, the swelling and stagnation of blood can cause pain and ultimately interfere with tissues in your legs, as well as make you tired – especially after you have been standing all day. Grades C5 and C6 mean that there have been (C5) or are (C6) ulcers, which can become infected, leading to potentially life-threatening complications. Having this condition at such a severe level is rare in young women. The backflow of blood and the resulting stagnation in the superficial veins also can lead to blood clots in these veins. Generally, this is not as dangerous as clots in the deep veins, but a small fraction of such superficial clots can produce the same complications as deep vein clots, particularly if the clots are near branching points close to where the superficial vein is sending blood toward the deep vein system. The ultimate dangerous complication of such clots, if they break away and travel through the blood as emboli (traveling clots) is a life-threatening lung condition called a pulmonary embolism. This is quite rare with superficial vein problems, but sometimes varicose veins are the result of an underlying problem that also is affecting the deep venous system, and this is why a thorough examination of your entire venous system is important.

Do swollen feet during pregnancy cause problems for the baby?

If swollen feet are the only problem with your venous system, this does not cause problems for the baby, even if you also suffer from varicose veins. However, if your swollen feet are the result of a problem in the deep venous system, the veins deep in the legs or pelvis to which blood from superficial veins is delivered, or if you develop a blood clot, the risk of venous embolism (a traveling clot) that could threaten your life threatens the developing baby as well.

What to consider about taking medications when you are pregnant:

  • The risks to yourself and your baby if you do not treat the swollen feet
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat swollen feet during pregnancy?

If there is evidence of clotting, or if your doctor considers you at risk for clotting, and if you have other risk factors (such as a history of smoking, being overweight, cancer) that make you especially prone to clotting, you may require anticoagulation therapy. Normally, the gold-standard treatment to prevent clotting is warfarin, but this is avoided during pregnancy as it can harm the developing baby. Instead, the treatment of choice against clotting during pregnancy is low molecular weight heparin (LMWH).

Who should NOT stop taking medication for swollen feet in pregnancy?

If you require LMWH, this means you are at high risk for clots, so you need to continue with the treatment.

What should I know about choosing a medication for swollen feet in pregnancy?

You may find Pregistrys expert reports about the individual medications to treat swollen feet here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for swollen feet when I am breastfeeding?

Neither warfarin (used in North American for long-term anticoagulation therapy), nor a similar drug called acenocoumarol (used in Europe) enter breastmilk or otherwise affect a nursing infant. LMWH does enter breastmilk, but in very tiny amounts and is not harmful because it is degraded in the infants digestive system (LMWH is not taken orally for this reason, but must be injected or infused).

What alternative therapies besides medications are there to treat swollen feet during pregnancy?

The principle treatments for swollen feet are not medications, but compression stockings and exercise. When swollen feet are connected with severe cases of varicose veins, the main
treatment consists of sclerotherapy and other surgical approaches, which work by closing up the affected vein. Vascular surgeons will want to wait for a few months after you give birth to see if your condition improves on its own since its the hormonal changes of pregnancy that aggravate varicose veins. Many surgeons also prefer to wait until you are finished breastfeeding.

What can I do for myself and my baby when I have swollen feet during pregnancy?

Be reassured that this is generally not a life-threatening condition, as long as you dont develop clots and sores, it will often resolve completely or in part after pregnancy. Remember to take breaks from standing as often as you can – especially during late pregnancy, wear compression stockings, and put your feet up when possible.

Resources for swollen feet during pregnancy:

For more information about swollen feet during pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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