Pregnancy and Varicose Veins

I have a lot of patients who come to California Vein Specialists with concerns and questions about problems with varicose veins during and after pregnancy.  Pregnancy is the most important risk factor for developing varicose veins in patients who are genetically predisposed to vein disease.   Varicose veins usually make their first appearance during pregnancy.  Population studies have shown that only 12% of women who have varicose veins have never been pregnant! There are many reasons pregnancy has an adverse effect on leg health.  Total body fluid increased 40 to 50 % and there is significant sodium retention.  This may cause edema (swelling) in the lower legs and ankles. 

Hormonal effects are responsible for the venous dilation that occurs during pregnancy.  High levels of the hormone progesterone weaken vein walls.  Estrogen causes veins to dilate. Relaxin also causes the veins to dilate. The enlarging uterus in pregnancy causes the large femoral veins to become obstructed.  This causes an increase in the venous pressures of the lower legs.

Pregnancy also a significant risk for superficial and deep venous blood clots.  Many coagulation factors are activated during pregnancy.  This hypercoagulable state may increase the risk of a blood clot, especially postpartum. This hypercoagulable state is caused by the increased blood volume, the enlarged uterus which obstructs venous return, and elevated hormonal levels that increase vein distensibility. So there are many changes in maternal anatomy, physiology and metabolism that contribute to the development of varicose veins and venous disease, but there are things you can do to reduce the risk.

Graded compression hose worn during pregnancy can reduce the pressure in your legs and the swelling.  It is a good idea to wear them when you are going to be standing for long periods or sitting for long periods.  Elevating your legs as much as possible is also helpful.  Graded compression hose also are proven to reduce the risk of blood clots so it should be worn before, during and immediately after delivery.  Early ambulation after delivery is also important to reduce your risk. If you have a history of blood clots or someone in your family has a history, you should have a thrombophilic risk work up.  This is a series of blood test to see if there are factors in your blood that make you more prone to clots. If you are found to be at risk there are steps that can be taken to reduce your risk. Exercise is important.  Any exercise that develops a good calf muscle is important.  Remember the calf muscle is the main pump that pumps blood through the veins. Walking, hiking, swimming and biking are all great for leg health during pregnancy. A lot of my patients are avid runners, I think it is important to wear compression hose if you plan to continue running during your pregnancy. This will help reduce the pressure in your legs and may help protect the valves.  Try to sleep on your left side.  The uterus compresses the pelvic veins and vena cava more when lying on your right side.   This in turn increases the venous pressure in your legs leading to more strain on the valves.

Leg treatments during pregnancy

In general leg vein treatments should be postponed until after the pregnancy and after you have completed breast feeding.  Hormonal changes may remain four to six months postpartum.  Many times the enlarged veins of pregnancy may become normal again after the hormonal influence has been reduced. Sclerotherapy solutions are very safe, but should not be administered during pregnancy or lactation.

Other vein problems after pregnancy

Pelvic obstruction may be a cause of vulvar varicosities.  This can occur in the third trimester.  Vulvar varicosities that remain after pregnancy may become quite painful, usually during menses or even intercourse.  They are easily treated with sclerotherapy, usually with complete resolution.

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