Overview

Lymphedema is a condition that causes body tissues to accumulate lymph fluid and swell, particularly in the arms and legs.¹ Lymphedema can either be inherited or developed throughout life due to various factors. Pregnancy is considered one of the factors that can support the development of lymphedema. Whether you have lymphedema or are at risk of developing it and you are considering starting a family, with the right care and support, you can overcome potential challenges and manage symptoms. 

What Is Lymphedema?

Lymphedema is a condition of the lymphatic system. The lymphatic system includes vessels, nodes, and organs (spleen, thymus and tonsils), and it is responsible for keeping your lymph fluid levels balanced, filtering out harmful substances, and defending your body against illness. 

When the lymphatic system malfunctions, it fails to adequately drain lymph fluid, leading to an imbalance in the body's fluid distribution and subsequent accumulation in the soft tissues. When the lymphatic system is impaired, it cannot drain the lymph fluid, leading to an unbalanced fluid ratio in the body and accumulation in the soft tissues.

The physical signs of lymphedema include:

• Swelling in certain parts of the body
• Thickened, folding skin
• Bumpy, wart-like skin growths 
• Oozing skin¹

The areas most usually affected are the arms and legs. 

Generally, the symptoms are accompanied by a constant heavy feeling and difficulty with movement. 

What Causes Lymphedema?

Lymphedema appears as primary and secondary

Primary lymphedema is caused by a genetic mutation that is passed down from parents to their offspring. The mutation leads to an impaired lymphatic system. It can appear at any stage of life, starting from birth.

Secondary lymphedema can result from an infection. Lymphatic filariasis, a tropical disease caused by roundworms, can result in lymphedema if left untreated. Cancer can also cause lymphedema. In developed countries, a large number of lymphedema cases as a result of cancer are due to breast cancer.

Secondary lymphedema is more common than primary lymphedema, affecting about 1 in every 1,000 Americans, while primary lymphedema affects only about 1 in 100,000 people.²

How Pregnancy Can Affect Lymphedema

Pregnancy is known to be a phase of intense stress and changes for the female body, from hormonal changes to physical changes. 

The female body undergoes major shifts in the way it functions to be able to accommodate a growing life. Some of the hormonal changes the body undergoes result in an increased amount of lymphatic fluid.

The body’s natural lymph drainage system cannot always keep up with the increased amount of lymphatic fluid production, and this may show up as edema, particularly in the legs. 

Additionally, the growth of the abdominal area and the uterus can put pressure on the lymphatic vessels, and prohibit the effective drainage of all lymph fluid. On top of that, hormonal changes such as increased progesterone, estrogen, human-chorionic gonadotropin hormone (hCG) and prolactin can contribute to swelling.³

While lymphedema is not one of the typical symptoms during a pregnancy, some women may experience it for the first time. For women who already have lymphedema, symptoms may worsen during pregnancy. Fortunately, there are effective ways to ease symptoms and maintain comfort while enjoying this exciting new chapter.

Managing Lymphedema During Pregnancy

Dealing with lymphedema, particularly when pregnant, can be challenging, and the symptoms can impact your physical and psychological health. 

While there is no cure for lymphedema, your obstetrician/gynaecologist (OB-GYN) and lymphedema therapist can provide a personalised care plan to ensure that lymphedema causes the least possible implications to your health and pregnancy. 

Some general tips that are known to help with lymphedema symptoms include:

Gentle Movement and Exercise

Staying active during a pregnancy (with your doctor’s approval) can have many benefits, including improved lymphedema symptoms. Gentle, low-impact movement promotes better circulation of the lymphatic flow, which can reduce swelling and discomfort.⁴

Examples include:

• Walking
• Prenatal Yoga
• Swimming
• Stretching

Any of these exercises are, in most cases, safe activities for pregnant women and can make a big difference. 

If you perform any of these activities while pregnant, make sure to listen to your body, stop when it gets too much, avoid standing or sitting for too long, and always stay hydrated. 

Always consult with your healthcare provider regarding exercising during pregnancy. 

Compression Garments

Compression wraps and bandages can help with swelling. They are used to move “trapped” lymph fluid out of the affected area, reduce the accumulation of fluid in that specific area and promote lymph fluid circulation in the lymph vessels.⁵

Compression garments can provide relief from symptoms of heaviness and swelling, and they are most effective when used in conjunction with gentle exercise. 

Rest

When it comes to lymphedema, rest is as important as gentle movement. A good balance between the two can help in the process of healing from lymphedema symptoms. 

While resting, elevating swollen hands and/or legs readjusts gravity and can move excess lymph fluid out of the swollen site.

Skin Care

One of the most challenging parts of lymphedema is when it affects the skin, causing changes in skin texture. Without appropriate care, lymphedema can lead to hyperkeratosis, fibrosis, and open ulcers. These skin changes make the skin susceptible to infections and cellulitis.⁶

When a body part is swollen, it is important to regularly check the skin in that area for any changes in appearance and texture, as this can be a sign of early infection. If suspected, frequent cleaning and moisturising of the area can reduce the likelihood of infection. 

Massage 

A massage technique called Manual Lymphatic Drainage (MLD) can help lymph fluid circulate appropriately in the lymphatic system and reduce swelling.⁷

It is advised to always consult with your healthcare provider before trying any new routine. 

Possible Triggers to Avoid

Certain lifestyle and clothing choices can make lymphedema symptoms worse. These include:

Hot temperatures

Warm baths or saunas can cause heat edema, which can make your arms or legs temporarily swell. Lukewarm water, instead, is a safer option to avoid triggering symptoms. 

Tight clothes

Clothing that does not allow comfortable movement can interfere with lymph circulation. Additionally, tight clothing made from synthetic textiles can be harsh on the skin, making lymphedema symptoms worse. Choosing to wear loose, comfortable clothes when there is a flare-up of symptoms can be a safer option. 

Massages that aren't done by trained professionals

Massages can boost blood and lymph circulation, but not all types of massages are effective for promoting lymph circulation when dealing with lymphedema. The message technique mostly used is MLD and it is performed by specialised therapists, who have expertise on how to move fluid to the right lymph sites, where it can be drained. 

Simple Lymphatic Drainage (SLD) is a self massage technique that specialised therapists can teach you, to give relief to yourself when needed.⁷

Postpartum Considerations

After birth, the body experiences changes in fluid levels and hormone balance. This may cause a flare-up in symptoms.

If you are dealing with arm lymphedema and are breastfeeding, the posture and pressure can sometimes increase swelling. 

Continued check-ins with a specialist will help you manage symptoms, and adjust your post-delivery care plan as needed. 

Emotional Support and Mental Wellbeing

Living with lymphedema can feel challenging and overwhelming, especially during pregnancy. 

Sharing your feelings with the people around you can help them understand better how life with lymphedema is and how they can best support you.

Additionally, communication with other pregnant women who have gone through lymphedema or are currently dealing with it can provide validation and encouragement. Support groups are a great way to connect with others in this way.

Looking after your mental wellbeing while dealing with lymphedema, and particularly when you are pregnant, can make a big difference in your psychological health during these times. 

FAQs

Does lymphedema interfere with a pregnancy?

Lymphedema does not affect the baby’s health during gestation. However, primary lymphedema may be inherited by the baby. 

Is it safe to become pregnant with lymphedema?

With the right care plan from your healthcare provider, you can effectively manage symptoms and have a safe pregnancy. 

What should I avoid if I am pregnant and have lymphedema? 

Whether you are pregnant or not, it is advised to avoid activities that can trigger or worsen lymphedema symptoms. These include showering with hot water, hot-temperature environments (such as saunas), and wearing tight, synthetic textile clothes. All these lead to impaired lymph circulation, and can make swelling worse. 

Summary

Being pregnant and dealing with lymphedema can feel like a heavy burden at times, but with a personalised care plan and psychological support, you can have a smooth pregnancy. By consulting your healthcare provider, you can get informed of what to expect and what actions you can take towards limiting and easing any lymphedema symptoms. 

Lifestyle changes, including exercise and using compression garments can offer instant and long-term relief to swelling and heaviness symptoms. Additional steps such as skin care can ease symptoms and prevent infections. 

It is important to consult your healthcare provider before trying any relief method. With the right medical support, you can be best supported during your pregnancy. Small, consistent steps can make a big difference in feeling your best.