Before Heidi Harper had her first child five years ago, she had a "barely noticeable" bluish vein on the inside of one calf. But by the time her third child was born last summer, the vein was "a big, twirling, squiggly thing" that ran down the inside of both of her legs.
"It looked terrible," says the Summit, New Jersey, mom. "It didn't keep me from wearing shorts, but I was very self-conscious."
Harper's varicose veins -- a common condition in which large veins in the legs become enlarged and congested with blood -- are just one of many foot and leg problems that can occur during pregnancy. While some are temporary, others may stick around and progress.
So what causes these mysterious maladies, and what can you do about them? Here's what you need to know to give yourself a leg up now -- and after your baby is born.
If you develop varicose veins during pregnancy like Harper did, take heart: They're a common badge of motherhood. In fact, according to the American College of Phlebology, up to 50 percent of American women have varicose veins, especially women who are pregnant.
Varicose veins occur when tiny valves inside large leg veins, which normally scoop up blood and propel it against gravity toward the heart, don't function well. As a result, blood doesn't flow efficiently, pooling in leg veins and causing them to enlarge and become visible.
Unfortunately, this genetic condition tends to worsen with each pregnancy. Several factors contribute to varicose veins in pregnancy, says Luis Navarro, MD, director of The Vein Treatment Center, in New York City: "the increase in female hormones, which relax vein walls; a growing uterus, which puts pressure on veins inside the abdomen, making it more difficult for blood to circulate in the legs; and the fact that blood volume doubles during pregnancy." (More blood gives veins a bigger job to do.)
Of course, bulging veins can be unsightly. Fortunately, though, varicose veins pose no health risk for you or your baby.
To get relief: Wear compression stockings (aka support hose). Working with your calf muscles, the stockings help the blood in your leg veins circulate by producing upward pressure from the outside in. Your ob-gyn can advise you on the level of compression you'll need.
After you deliver, varicose veins may naturally shrink. But if the veins are still present three months after delivery or if your ankles or legs are still swollen and feel heavy, it's time to see a doctor. All are signs that the valves in your legs veins are not doing their job. Treatment options vary depending on the extent of your condition, ranging from minimally invasive outpatient procedures to those that require general anesthesia and a short hospital stay.
A close cousin to varicose veins, spider veins are also common during pregnancy. Also genetic, spider veins occur when tiny blood vessels near the skin's surface dilate due to increased hormone production in pregnancy.
Roughly 60 percent of women with varicose veins will also have spider veins, estimates Dr. Navarro. Although they may burn, spider veins are simply a cosmetic issue, he says. Those that don't disappear after baby is born can usually be treated, though insurance will seldom cover it.
When she was seven months pregnant with her third child, Mary K. Talbot's feet and ankles were so swollen, "they looked like purple sausages," says the mom from Barrington, Rhode Island.
Edema (the medical name for Talbot's condition) is common in pregnancy, especially in the third trimester, and isn't necessarily a reason for concern. In addition to swollen feet, edema can also cause swelling in your face and hands.
"Edema typically occurs when the uterus enlarges and presses on the vena cava [a large vein on the right side of your body] and impairs circulation," says Rini Ratan, MD, assistant director of labor and delivery at Columbia-Presbyterian Eastside, in New York City.
Consequently, blood pools in your legs, the veins swell, and some of the fluid from these veins leaks into the supporting skin tissues. Fortunately, the condition is temporary and often goes away within a week of delivery.
To get relief: Wear support hose to enhance circulation and avoid sitting or standing for more than an hour. Walking increases blood circulation, which helps alleviate puffiness. Elevating your legs can also help.
Try not to lie on your right side or flat on your back, which puts the full weight of your uterus on the vena cava. Instead, lie on your left side, a position that exerts the least amount of pressure, says Dr. Ratan.
Also, be sure to drink plenty of water, which actually helps keep the body from retaining water, and wear comfy shoes -- even slippers -- whenever possible.
"Growing," Achy Feet
Speaking of shoes, it's not uncommon during pregnancy to go up at least half a shoe size. Why? "Pregnancy hormones, such as relaxin and estrogen, cause the joints and ligaments in your feet to relax," says Jane Andersen, a podiatrist in Chapel Hill, North Carolina, and a spokesperson for the American Podiatric Medical Association.
When joints and ligaments loosen, the feet elongate. Pregnancy weight gain can also contribute, causing feet added stress.
To get relief: Get your foot remeasured when you're shoe shopping and go with the flow. If you have to go up a half to a full size, so be it.
Killer nighttime leg cramps are typical, especially in the third trimester. Increased pressure on the uterus can compress nerves in the legs, which boosts the likelihood of leg cramps.
"During the last half of my pregnancy, I had leg cramps that would wake me up from a deep sleep," says Jennifer Pisano, a mother from Phoenix. Edema and varicose veins may also be contributing factors, although the connection between these conditions and cramps isn't clear.
To get relief: As a preemptive strike, try to stretch your calves during the day and before you go to bed by pointing your toes toward the floor if you're lying down, then flexing your toes toward your head. Do the same when a cramp hits, or try massaging your calf muscle. If neither of those works, get up and put pressure on the muscle by standing.
Cramps, like most foot and leg problems, will likely go away after your baby is born. Still, the little steps you take in pregnancy can go a long way to increase your comfort level.
Sandra Gordon is a writer in Connecticut.
Originally published in American Baby magazine, February 2005.