Women, Pregnancy and Vein Health

By Cindy Asbjornsen, DO, FACPh P

regnant women experience a multitude of physical changes as their bodies prepare for birth. Some changes are exquisite – others, not so much. Safe to say, you can put varicose veins in that latter category.

Varicose veins are a symptom of venous disease, or the impair- ment of blood flow back towards the heart. This impairment occurs when healthy vein valves become damaged and the backward flow of blood “pools” in the legs or feet. Symptoms may present as discomfort, fatigue, or heaviness in the leg, as well as varicose veins and other skin changes. Over time, the increased pressure can cause additional valves to fail. If left untreated, it can lead to extreme leg pain, swelling, ulcers, and other health problems.

Why Varicose Veins? About forty percent of pregnant women are likely to develop

varicose veins. During pregnancy, a combination of hormonal changes— specifically, greater amounts of estrogen and progester- one— and increased pressure on the abdomen can cause varicose veins to manifest. Interestingly, the most damage seems to happen in the first trimester, so those with known risk factors for venous disease should be instructed to wear graduated compression stock- ings throughout the first three months of pregnancy and possibly longer.

The volume of blood in a healthy woman increases by about 50% more than before the pregnancy, with the largest increase in the second trimester. With more volume to move, all of the blood vessels are under increased stress and veins can become very swol- len. In the final trimester, the expanding uterus can put pressure on the inferior vena cava, and further restrict proper venous return to the heart.

Pregnancy is also a time when women are more prone to blood clots, so phlebitis (inflammation of the walls of a vein that can cause a clot to form) can also be a concern.

14 ELM™ Maine - May/June 2018 Prevention During Pregnancy

A common complaint during pregnancy is swollen ankles. Due to the increase of blood volume and fluid, retention of fluid can cause swelling in the ankles, feet, and legs. But there is something that can help. Graduated compression stockings pro- mote circulation and venous efficiency, which helps to reduce swelling and pain— and, in many cases, can prevent or mini- mize varicose veins.

Ideally, any woman with a positive family history should wear full-length stockings (or at least knee-high stockings) throughout her entire first trimester. Stockings come in a vari- ety of styles and strengths, from knee-highs and thigh-highs, to full-length stockings. For pregnant women, there are even panty hose styles with more room in the belly, specially designed to expand during pregnancy without restricting the abdomen. They are graded on the basis of the strength of the compression at the ankle. Commonly prescribed strengths include: 15-20 mmHg for spider veins or patients with varicose veins, but only mild symp- toms or swelling; 20-30 mmHg for mild to moderate varicose veins; and 30-40 mmHg for patients with varicose veins associ- ated with symptoms such as pain and swelling.

Maternity graduated compression stockings are specially designed to fit more snugly at the ankles and calves and less so toward the top. The gradual change in compression helps the weak valves in the veins to circulate the blood more effectively. Though pregnancy compression stockings (and body garments) are available with a doctor’s prescription, many maternity stores also offer them. Accurate sizing is critical, so it is best to check with a doctor prior to purchasing any type of compression while pregnant. If you do try a pair of compression stockings and don’t like them, don’t give up. You may not have found the right fit or brand yet. Before you purchase maternity stockings, be sure to ask what the return policy is.

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