How to Prevent Swelling During Pregnancy?

Overview

Swelling, also known as an oedema, is a common occurrence in pregnancy, yet, many people suffer anxiety due to these physical changes. More than 80% of pregnant people suffer from swelling towards the end of their pregnancy, especially in their lower limbs.¹ This is usually due to the extra fluid the body holds onto during the development of the foetus. 

The amount of swelling can be reduced if the following steps are taken:

1. Reducing salt intake
2. Eating a balanced diet 
3. Getting involved in prenatal exercises and prenatal massages
4. Staying well hydrated
5. Eating foods rich in vitamins

While swelling is very common, it can also be a sign of something more serious, especially if it is accompanied with other symptoms. If you are worried or notice any other symptoms consult your doctor and they will be able to tell you whether the swelling is normal or a symptom of another medical condition.

Why does swelling occur during pregnancy?

During foetal development there are a lot of physical and physiological changes, such as swelling.²  In order to support the developing foetus, the body increases the rate of production of blood and body fluids by approximately 50%.  When excess fluid accumulates in the body’s tissues, swelling occurs.  

Aside from an increase in blood volume, swelling could also be due to adenomyosis (an enlarged uterus), weight gain or changes in hormones.¹  This excess fluid retention enables body expansion as the baby develops and also helps in preparing the pelvic joints and tissues for delivery.  The pressure of the growing womb could also cause a change in blood flow, thereby allowing fluid to build up in the lower extremities causing swollen ankles, legs and feet.

In certain situations, swelling also arises due to high blood pressure and weakening of the veins in the leg to send blood from the limbs back to the heart. This could be referred to as 

venous insufficiency.  The swellings may be small initially, occurring in the ankle area and, depending on the duration and severity of the inability of the veins to send blood back to the heart, they gradually become larger.¹  Venous insufficiency is found to be a cause of varicose veins which is a common occurrence in pregnancy.³ A varicose vein, sometimes called varicosity, occurs when a valve weakens, putting more pressure on other valves and causing blood to stagnate.³  The vein then becomes distended, its walls stretch and sag, allowing the vein to swell in that region into a miniature balloon near the surface of the skin.  The veins in the legs are most commonly affected as they are working against gravity.

Usually, the appearance of swelling in the later part of pregnancy is usually not a cause for alarm but in certain cases could be an indication of a serious, medical complication, such as deep vein thrombosis (DVT) and pre-eclampsia.⁴

DVT is a medical condition whereby a blood clot is formed within a deep vein, usually in the legs or pelvis. The most obvious symptoms include swelling, redness and itching.⁵  Pregnancy is one of the risk factors that predisposes people assigned female at birth (PAFAB) to thrombosis.  Thrombosis in pregnant PAFAB is 6 times more common than in non-pregnant PAFAB. The greatest risk of thrombosis occurs in the third trimester of pregnancy, during childbirth and during the postpartum period. The most dangerous complication of thrombosis is a pulmonary embolism (present in around every 1 out of 2,000 pregnancies) and is the most common cause of death amongst pregnant PAFAB.¹  

Preeclampsia is a life threatening medical condition characterised by high blood pressure and by the presence of protein in urine. The common symptoms of preeclampsia are persistent headaches and unusual swelling of the hands, feet, ankles and face.

Body parts that swell during pregnancy

Normal swelling is experienced in the hands, face, legs, ankles and feet.  Swelling in the lower extremities (the ankles and legs) are quite common compared to swelling in the shins, knees, palms and fingers which are affected to a lesser extent (especially during the third trimester of the pregnancy).⁴  The risk of oedema is usually increased due to standing or sitting at a lot.¹

Different ways to prevent swelling during pregnancy

Swelling in pregnancy could be prevented or reduced by following these steps:

1. Reducing salt intake - salt is known to retain fluid in the body, which increases the fluid in the body, causing swelling.  You can reduce your salt intake by eating less highly processed or pre-packaged foods
2. Eating a balanced diet - this contributes to obtaining a healthy weight during pregnancy.  This involves eating more fruits and vegetables whilst eating less sugars and fats
3. Getting involved in prenatal exercises - sitting or standing for too long causes fluid to build up around the ankles and feet. Exercises like walking and swimming can help reduce swelling
4. Drinking more fluids - a hydrated body retains less fluid, which reduces swelling
5. Consider seeing a certified massage therapist who specialises in treating pregnant women - some research suggests foot massages and reflexology may help relieve an oedema in pregnancy
6. Prop up your feet - this helps to prevent fluid from accumulating in the lower extremities

Unfortunately, not all swellings in pregnancy are due to extra fluid. Some are an indication of a serious medical complication.

Treatment

When swelling occurs, what should I do about it?

The same steps taken to avoid swelling need to be taken if swelling does occur.  Additional steps such as the use of compression therapy are recommended. Compression therapy can be introduced in the treatment of swelling of the lower extremities and there are several forms including: elastic bandages, inelastic bandages, boots and socks. 

There are studies that show that compression therapy can even relieve the symptoms of varicose veins and oedema in people whose professions require them to spend long periods standing.⁶  A study found that the prevalence of pain, oedema, and sensations of swelling in the lower limbs at the end of the gestation were all reduced in the group of pregnant PAFAB who had worn compression socks, demonstrating the efficacy of this treatment. It was concluded that compression stockings were an effective measure for prevention of lower-limb oedema in pregnant PAFAB, who reported positive perceptions of wearing them.⁶

When to call a doctor?

When the swelling is noted to be sudden and severe, it could be an indication of a more severe condition such as deep venous thrombosis (DVT) or pre-eclampsia.  Make sure to call a doctor if:

• Swelling is noted on one leg or significantly more in one leg than the other 
• There is pain or tenderness in one calf or thigh, which may feel like cramping or soreness
• There is warmth, redness or discoloration in the affected leg

These are all signs of DVT and should be taken seriously as it can be life threatening.

You should also call your doctor if you notice: 

• Excessive and/ or sudden swelling of your feet and ankles
• Persistent headache
• Sudden weight gain
• Abdominal pain 
• Shortness of breath

These are all signs of pre-eclampsia and again they should be taken seriously.

Summary

Swelling or (oedema) in pregnancy is very common as the body increases fluid production during the development of the foetus. It's a manageable and preventable condition that doesn’t pose a risk to the unborn child.  Simple steps such as eating a healthy balanced diet low in salt, increasing your fluid intake and not standing or sitting for long periods of time all help to reduce swelling during pregnancy.  If you notice other symptoms alongside the swelling then you should visit your doctor as it could be a sign of something more serious.