Lymphoedema and Pregnancy: knowing the connection, causation and consequences

 This can prompt conditions to arise that your body was previously able to keep under control. Lymphoedema is a chronic condition that causes fluid to build up in one or multiple areas across the body, producing visibly enlarged and swollen limbs. Untreated, it can result in fibrosis of the skin and patches of cells becoming starved of oxygen, creating a haven for bacterial infections.

Lymphoedema can occur for one of two reasons: due to an underdevelopment of the lymphatic systems, known as primary lymphoedema, or as a result of damage to the lymphatic system often following surgery or radiation therapy, known as secondary lymphoedema.

Primary lymphoedema: An overview

Primary lymphoedema occurs because of developmental problems with the lymphatic system: this can be due to a genetic condition, or simply an individual abnormality. The visible symptoms associated with the condition can also present at any stage in life: some babies are born with evidence of swelling, while others may notice symptoms starting later on in life (usually in childhood, adolescence or after 30 years of age).

• The incidence of primary lymphoedema at birth is considered to be around 1:6000, while its prevalence in patients under 20 years of age is approximately 1:87,000 .
• Women are more frequently affected by primary lymphoedema.

The link between swelling and pregnancy

It goes without saying that pregnancy brings enormous stress upon the body. During pregnancy, your body creates almost 50% more fluid and blood to support the needs of your growing baby . This can prompt conditions to arise that your body was previously able to keep under control. When it comes to pregnancy and swelling, the main catalysts are:

• Extra fluid putting the lymphatic system under stress
• Hormonal changes taking place (increased level of progesterone, oestrogen, HCG and prolactin)
• Changes in vascular permeability prompting leakage of plasma and consequent enema
• The developing weight and size of the foetus putting pressure on the inferior vena cava

What is oedema and how is it different to lymphoedema?

Oedema is the term used for fluid build-up that occurs in your body’s tissues. It can be the result of many things, such as taking certain medications, and is very common during pregnancy.

Oedema is most frequently experienced in the lower legs during pregnancy as the increased weight of the body and extra fluids begin to collect and pool due to gravity. Swelling may be experienced at any point during pregnancy, but it tends to be noticed around the fifth month and can increase in the third trimester.

Generally, oedema caused by pregnancy pressure will begin to dissipate one to two days following birth. Should the swelling persist, however, this can be a sign that the problem lies with the lymphatic vessels. The key lymphoedema-related symptoms to look out for are:

• Pitting, i.e. pressure to the affected area leaves behind a visible imprint
• Hardening of the skin or signs of discolouration around the limb

How can I control swelling during pregnancy and after?

There are several ways you can help to manage lymphoedema-related swelling both during and after your pregnancy. First and foremost, of course, it is important you speak with your doctor, mid-wife or primary caregiver to discuss your symptoms and ensure all actions taken are suitable both for you and your baby. Be prepared to learn that pre-existing swelling may potentially worsen; unfortunately, there is no way to know whether or not you will be adversely affected prior to conceiving.

Lymphoedema management tips for pregnant women

Managing your lymphoedema during pregnancy should be a similar process to during non-pregnancy, although it may perhaps require a little extra attention given there are two of you to consider! A few important points to remember are:

• Wear your compression stockings every day and keeping your legs elevated at night.
• Discuss with your caregiver how you can enhance your day and night routine to counteract any additional swelling e.g. with bandaging, night garments or more Manual Lymphatic Drainage sessions.
• Stay off your feet whenever possible. The increased weight you experience during pregnancy exacerbates lymphatic problems in the legs.
• Try not to overeat. We all know how difficult it can be to avoid the cravings, but just remember that any extra weight you have to carry has a direct effect on your swelling.
• Stay out of the sun! Heat amplifies the discomforts of compression stockings.
• Keep active. As the baby weight starts to create all sorts of aches and pains, exercising may be the last thing you want to do. But remember: any kind of activity will help keep that lymphatic fluid flowing. Swimming, for instance, is a great option.

Finally, if there is one thing, we want to emphasise it is that you can and should ask for help! Pregnancy can be difficult, stressful and overwhelming – and that’s without suffering from lymphoedema. Gwendolyn Pilat Herchek, a mother of two whose lymphoedema arose during her first pregnancy, had these words of advice for other women like herself:

“Don’t feel frustrated and alone. Take one day at a time, eat right, massage and wear the garments at all times. You will naturally have swelling along the way due to pregnancy, but you should always wear the garment to help with any extra excess fluid build-up. Try to elevate and rest the leg when at all possible. And most of all? Just enjoy the pregnancy!”

Remember that it is in both your and your baby’s interests to ensure that you receive the care and attention required: attend all of your check-ups, and be sure to seek assistance should your swelling begin to impede on your ability to perform massage, drainage, or put on your stockings.

For further advice on any aspect of managing your lymphoedema during pregnancy, or if you simply want the opportunity to chat with others living with lymphoedema, head over to LymphConnect’s platform.