Many women suffer from heavy, tired or swollen legs in pregnancy. The cause is the alterations in hormone balance that lead to the vessels becoming more distended. This is compounded by the increase in blood volume – by about 20 percent even in very early pregnancy.

Many pregnant women don’t realise that during pregnancy the veins have to work harder than before. This is due to the weight gain, the hormonal changes, the increased volume of blood in the body and the pressure of the baby on the pelvic area.

The weight gain also increases the pressure on the veins in the legs. The blood then flows more slowly back to the heart, particularly through the veins of the leg. Venous distension also leads to the situation in which the venous valves no longer close properly and the blood is then able to flow backwards. The blood pools in the veins, which makes itself noticeable as pins and needles, itching and pain in the legs. What’s more, the pooled blood causes fluid to leak out into the surrounding tissues, which causes the legs to swell up, with the ankles becoming particularly swollen. As a result of this, varicose veins can form, which should be shown to and monitored by the midwife.

Around half of all women develop varicose veins in their first pregnancy and even more women are affected by this in the second pregnancy.

The risk of thrombosis also rises: the risk of pregnant women suffering a thrombosis is three to five times higher than in non-pregnant women. In fact, this risk even continues to increase still further up to six weeks after delivery of the baby – particularly after a Caesarean section or following serious blood loss.

You can support the work of the veins with physical exercise and sport such as antenatal exercises, walking, swimming and cycling, because the transport of blood back to the heart is mainly boosted by the action of the leg muscles, the so-called muscle pump. Cold water causes the vessels to contract and promotes better blood transport.

This added stress may even have consequences for women who have never shown any signs of venous insufficiency before. The legs swell up and so-called ‘varicose veins in pregnancy’ develop, which often, but not always, disappear again after the birth. A pregnancy is not infrequently the beginning of permanent venous disease, particularly in women with additional risk factors – e.g. hereditary lax connective tissue or overweight.

Compression class 1 is sufficient at this stage. Compression class 2 can be used for existing vein problems or major accumulations of watery fluid. The stockings should be worn from the third month of pregnancy until two months after delivery or until the end of breast-feeding.

Whether it’s tights with an extra-comfortable panty section for the baby bump, hold-ups (thigh-length stockings) or knee socks: your doctor or midwife should be happy to advise you on finding the correct hosiery for your needs.

Furthermore, preventive measures against thrombosis are taken in hospital or in the obstetric clinic, if necessary. These consist of special compression garments, the thrombosis prophylaxis stockings, exercises and possibly also treatment with anticoagulation drugs.

If you are planning a home birth or an outpatient delivery, you should consult your doctor in good time about possible precautions.

The leg symptoms do not reoccur later in these mostly younger women. However, everybody who suffers from swollen legs should be examined by a doctor, in order to to find out whether a serious venous disease lies behind the symptoms.