Dear Doctor,

I am in the second trimester of my first pregnancy and it hasn’t been bad so far. The thing is, my feet have started swelling and it does not look good, I can barely fit in my sandals. What causes this and how do I get it to go down?

 Lina

Dear Lina,

Accept my congratulations and best wishes for your first pregnancy. Swelling over the feet, or pedal edema as it is called, though worrying, is normal during pregnancy as it advances.

As pregnancy advances, gravid uterus grows in bulk and presses on the lymphatics and veins of the lower limbs. Due to this pressure, fluid oozes out from the veins into tissues, causing pedal edema. The flow of blood is increased throughout the body, during pregnancy, contributing to the pedal edema. It is also due to the effects of the hormone progesterone.

However, swelling over the feet during pregnancy, can also be due to some disease conditions. UTI (urinary tract infection), is more common in women due to multiple factors and this vulnerability increases during pregnancy.  Some women tend to develop high blood pressure during pregnancy, which can cause eclampsia, a potentially fatal condition, needing urgent therapeutic intervention. Pedal edema occurs as one of the manifestations of eclampsia of pregnancy. However, this would be accompanied by very high blood pressure, passing of proteins in the urine, headache, loss of consciousness, and other features. Under functioning of the thyroid gland (hypothyroidism) may be precipitated during pregnancy in those vulnerable to it and swelling of feet is one of the manifestations.

Some women develop heart failure during pregnancy, due to damage to heart muscle caused by hormonal changes (peripartum cardiomyopathy) and increased blood flow in all vessels throughout the body. Pedal edema occurs in such cases, along with engorged jugular veins and breathlessness on walking and even rest. Use of steroids during pregnancy can lead to pedal edema

Initially, the swelling may be intermittent, occurring on walking or standing continuously for long time. But later on it may become chronic with progress of pregnancy. It is visible clearly, hence, diagnosed easily. On pressing with a finger, a dent is visible over the feet and or ankle and around it.

As pedal edema appears, it is prudent to exclude a treatable medical condition by relevant investigations.

Keeping the legs elevated, avoiding sitting with legs dangling below for a long time, are measures that help in reducing the edema, as such positions reduce pressure over the veins. It is advisable to keep legs elevated for one to two hours per day. Wearing elastic stockings during waking hours helps in easing the pressure over the blood vessels of the legs, thus preventing or minimising pedal edema.

A healthy lifestyle, including salt restricted diet and drinking much water, helps in preventing UTI, and resultant pedal edema. Smoking, alcohol use, excess of caffeinated products are risk factors that can cause high blood pressure, leading to eclampsia of pregnancy. Stress, both physical, as well as mental, is also a risk factor for high blood pressure and heart problems, both conditions that can cause pedal edema. Hence, these are best avoided. Somebody affected by high blood pressure should adhere to dietary restrictions and regular treatment, to avoid shooting up of hypertension and eclampsia.       

 Dr. Rachna   Pande is a specialist in internal medicine.