Dr. Aggarwal is a Board Certified and Aesthetic Laser Certified Family Physician specializing in vein disease at the Vein Care Center in Ohio.She is the Medical Director of the center’s IAC Accredited Ultrasound Laboratory and a Preceptor for the American Vein And Lymphatic Society and the American Society for Laser Medicine & Surgery. Dr. Aggarwal received her medical degree from West Virginia University School of Medicine.
Pregnancy is a time of joy, excitement and celebration. It is also an important time to remind oneself of the cardiovascular changes that occur in the body and what can be done to optimize these changes as the pregnancy progresses. Many of these changes occur to meet the demands of the fetal and maternal metabolic needs.
In the first trimester, there is a decrease in peripheral vascular resistance (PVR). This means the vessels dilate and stretch, causing more blood to “hang out” in the vessels. These changes start as early as five weeks! This can cause edema (in the legs typically), pain and even discoloration in the lower legs. Hormonal changes also contribute to vessel distensibility, which causes stagnation of blood and increases the risk of varicose vein and blood clot formation.
Factors that increase the risk of developing a blood clot include obesity, age (over 35 years), multiparious pregnancy, c-section, smoking and history of blood clots. Despite these risk factors, pregnancy alone is a clotting risk that continues up to three months after a baby is delivered. Therefore, it is important to be proactive when it comes to your health during pregnancy. Pregnant women are five times more likely to have a blood clot than a non-pregnant woman. It is also well known that a blood clot in the lungs, called a pulmonary embolus, is the leading cause of maternal death in the developing weeks.
Venous disease is a genetic disease, and pregnancy can exacerbate an already “faulty gene.” With increased venous pressure due to the above-mentioned factors, it is important to optimize the venous system so that the heart can efficiently handle the increase cardiac output.
There are many ways to assist your body to handle the changing hemodynamics. One is to elevate your legs whenever you can. Elevation is helpful in decreasing pressure in the legs. The second way is to wear knee-high compression stockings during the day, for as many hours as you can. Compression stockings assist in the normal physiology of the body by bringing blood back up to the heart for recirculation. The stockings aid the calf muscle to pump venous blood, thus decreasing stagnation of blood and risk of blood clots and phlebitis.
Compression stockings are graduated, meaning they are tighter at the foot and become less tight as they go up the leg. For example, a 20-30mmHg level compression stocking has a pressure of 30mmHg on the ankle/feet and by the time it reaches the knee, the pressure drops to 20mmHg, to mimic the normal physiology of the body.
Though compression stockings do not prevent varicose veins, the quality of life measures have been shown to improve – such as leg heaviness, cramping and swelling. It has also been shown to be more cost-effective than to do nothing when you have symptoms. There aren’t any major studies that have shown an absolute positive necessity for compression stockings. However, given the known hemodynamic changes and possible outcomes of pregnancy-relation venous disease, compression seems like an easy chance to take on maintaining leg health.
Learn more about the benefits of using compression therapy during pregnancy.