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    Swelling During Pregnancy: What You Need To Know

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    Some of the common issues associated with pregnancy are weight gain, bleeding, nausea, cramps, vaginal discharge and pain in the abdominal area. While these pregnancy-related issues vary from woman to woman and also from pregnancy to pregnancy in the same woman, a feature that is commonly witnessed in almost all pregnancies is the swelling of the body.

    Swelling occurs during preganancy as the body has more blood and fluids during the entire gestation period. As per some estimates, it is believed that the production of fluids in the body is stepped up to as much as 50% above normal to address the additional needs and requirements posed by the pregnancy. With the expansion of the body for the accommodation of the growing foetus, more levels of fluids are secreted to lubricate the body and impart it a softness.

    Swelling During Pregnancy

    While weight gain during pregnancy is inevitable, there is indeed much variability in the different components [1] that contribute to the weight gain. Weight gain in pregnant women is caused by a combination of factors, such as foetus, amniotic fluid, placenta, breast and uterine tissue, maternal fat and extracellular fluids. These individual components change throughout the course of pregnancy, with certain pregnant women reporting somewhat lesser weight gain as compared to other pregnant women.

    The feeling of bloatedness, though a common feature in pregnancy, can be experienced differently by those pregnant. While a particular pregnant woman might feel very bloated at different stages of her pregnancy, some other woman might experience comparatively less bloating. It is the additional body fluids and blood that lead to this bloating. Oedema or swelling in the body is usually witnessed in the face, hands, ankles, feet and legs. This build-up of fluids in the body provides effective lubrication to the joints and certain tissues, thereby easing the delivery process.

    Swelling is usually quite significant from the fifth month onwards, progressing gradually right till the time of the delivery. The body parts that swell during pregnancy include the following.

    Feet

    With almost all women experiencing swelling in the feet, this is a fairly common pregnancy-related problem. Certain things that can offer relief from feet swelling are the following:

    • Soaking feet in warm water containing salt.
    • Raising the feet while sitting or lying down.
    • Simple leg exercises to facilitate blood circulation.

    With the overall increase in the body weight, the amount of pressure on the feet is also significantly increased, thereby leading to more strain on the legs in general and the feet in particular. It is estimated that in a typical pregnancy, the total body water increases 6-8 litres, out of which approximately 4-6 litres are extracellular or outside the cells, of which around 2-3 litres are interstitial or tissue fluid. [2]

    Lips

    Though not very common, swollen lips in pregnancy are also quite a natural occurrence and nothing to worry about as such. Caused by hormonal changes, puffed lips, if causing discomfort, can effectively be treated by applying butter or olive oil.

    Breasts

    Mammary glands, or breasts, are most affected by pregnancy. Tenderness in breasts, along with swelling, is reported by most pregnant women. As early as 10-15 days from conception, swelling sets in, and is due to the milk production that begins in the breasts.

    Nose

    Attributed to hormonal changes in the body, the nose can be seen to be puffed up noticeably in some women as the blood vessels swell. In case of any bleeding, ice should be applied. Women who experience a swollen nose are also advised to stay hydrated to control nasal swelling.

    Ankles & Legs

    With the increased pressure exerted on the body by the growing baby in the womb, it is but natural that ankles & legs also swell up. This is especially witnessed in the third trimester as the amount of fluid in the tissues builds up.

    Swelling in the legs, ankles and feet are jointly referred to as lower extremity oedema [3] , and can be seen in almost every pregnant woman in the third trimester.

    While swelling in ankles & legs are fairly common and nothing to worry about, medical supervision should be sought if there is an appearance of blood clots in the swollen area on the legs.

    Though not a dangerous condition, leg oedema causes symptoms such as night cramps, feelings of heaviness, pain along with paraesthesiae or numbness, tingling or burning [4] .

    Face

    Hormonal changes during pregnancy can also lead to facial swelling. While the swelling goes down on its own, a pregnant woman can do the following if she wishes to control the swelling on her face:

    • Facial exercises
    • Consumption of foods that are rich in Vitamin C.

    While rare, using permanent hair dyes during pregnancy might cause an allergic reaction leading to extreme swelling in the face. [5]

    Gums

    It is quite common for pregnant women to experience some amount of swelling in their gingiva or gums. This condition is referred to as gingivitis and causes sensitivity in the teeth, along with pain and well as bleeding from the gums. Flossing and brushing teeth twice a day can control the condition.

    Gingivitis is caused by the increase in female hormones - oestrogen and progesterone. It has been found in research of a cross-section of pregnant women that despite there being no changes in the plaque levels, the gingival index (GI) was comparatively higher, peaking in the third trimester [6] . This GI dropped somewhere around three months after giving birth.

    Veins

    Varicose veins, or swollen and enlarged veins, are a common occurrence in pregnancy and can be seen to affect as many as 40% of pregnant women. [7] These swollen veins appear as blue or purplish on the surface of the skin.

    The best way to control varicose veins is by raising your feet as much as possible while sitting or sleeping, and by wearing comfortable footwear and loose clothing.

    Vagina

    Typically seen towards the end of pregnancy - that is, the eighth and ninth months - a slight swelling in the vagina is owing to the pressure exerted by the weighted womb.
    Sometimes, reportedly affecting around 18% to 22% [8] of women during pregnancy, the veins in the labia majora, as well as labia minora, are significantly dilated. This condition is referred to as varicose veins of the vulva or vulvar varicosities.

    Oedema is a common occurrence in pregnancy. Studies have revealed [9] the following.

    • When compared to women who have had either little or no oedema, women who have had oedema in one pregnancy are twice as likely to develop oedema in the subsequent pregnancies as well.
    • Women who were heavier for their height at 20 weeks of pregnancy were more likely to develop oedema, when compared to women with an average weight.
    • With the blood pressure levels going up, the chances of developing oedema also go up.
    • Women with oedema in pregnancy tend to give birth to comparatively larger babies.

    Despite the above, oedema on its own, that is, without any other complications, is not harmful or unphysiological[9]. Oedema in pregnancy generally leads to comparatively higher birthweight in babies and lessens the chance of perinatal mortality.

    View Article References
    1. [1] Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy: Part I Weight Gain: Part II Nutrient Supplements. Washington (DC): National Academies Press (US); 1990. 6, Body Composition Changes During Pregnancy
    2. [2] Sciscione, A. C., Ivester, T., Largoza, M., Manley, J., Shlossman, P., & Colmorgen, G. H. (2003). Acute pulmonary edema in pregnancy. Obstetrics & Gynecology, 101(3), 511-515.
    3. [3] Reynolds, D. (2003). Severe gestational edema. Journal of midwifery & women's health, 48(2), 146-148.
    4. [4] Bamigboye, A. A., & Hofmeyr, G. J. (2006). Interventions for leg edema and varicosities in pregnancy: What evidence?. European Journal of Obstetrics & Gynecology and Reproductive Biology, 129(1), 3-8.
    5. [5] van Genderen, M. E., Carels, G., Lonnee, E. R., & Dees, A. (2014). Severe facial swelling in a pregnant woman after using hair dye. BMJ case reports, 2014, bcr2013202562
    6. [6] Wu, M., Chen, S. W., & Jiang, S. Y. (2015). Relationship between gingival inflammation and pregnancy. Mediators of inflammation, 2015, 623427.
    7. [7] National Clinical Guideline Centre (UK). Varicose Veins in the Legs: The Diagnosis and Management of Varicose Veins. London: National Institute for Health and Care Excellence (UK); 2013 Jul. (NICE Clinical Guidelines, No. 168.) 11, Pregnancy.
    8. [8] Gavrilov S. G. (2017). Vulvar varicosities: diagnosis, treatment, and prevention. International journal of women's health, 9, 463-475.
    9. [9] Oedema in pregnancy. (1967). British medical journal, 3(5556), 3-4.

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