During pregnancy, the mother foes through significant changes both anatomically and physiologically to accommodate and nurture the growing baby. These changes start after conception and affects all the organ systems in your body. In most women who have an uncomplicated pregnancy, the changes will gradually resolve after the delivery of the baby with minimal side effects. It can be important to know what the normal changes are so that you know when you should talk to your doctor about the issues or symptoms you have.
Common Body Changes That Occur During Pregnancy
Some of the changes that occur in your body when you are pregnant (in brief) are:
Plasma volume increases
This blood plasma is the yellowish component of blood that holds blood cells in suspension. It contributes to 55% of your blood volume. In pregnancy, the plasma volume increases. Since it’s increase is more than the increase in red blood cells, your hemoglobin, hematocrit and red blood cell levels may appear to be low. This is known as dilutional anemia and is normal in pregnancy.
Iron levels increase
In pregnancy, there is an increase in the requirements of iron by two to three times more for additional hemoglobin production, for the baby, and production of enzymes. Folate requirements increase by 10 to 20 times more while vitamin B12 has a two-fold increase.
Coagulation of blood
To anticipate blood loss during delivery, there is an increase in coagulability in pregnant women. This means that your blood clots faster and easier compared to individuals who are not pregnant to prevent excessive blood loss when you deliver your baby.
Cardiac (Heart) blood pump increases
By the time you are 2 months pregnant, the output of your heart (blood pumped out by the heart) has increased by 20% and eventually to 40% at weeks 20 to 28.
Adrenal glands and pancreas produce multiple hormones
The adrenal glands produce multiple hormones, one of which is cortisol. In pregnancy, cortisol levels increase, and this leads to fat storage. The pancreas produces insulin. The insulin levels increase to ensure that your blood sugar will stay normal or low.
Increased oxygen consumption
There is increased oxygen consumption by about 20% since the increased metabolic rate is the cause of more oxygen demand.
Gastrointestinal tract reduces motility
Common knowledge is that nausea and vomiting is common in early pregnancy. The appetite increases and there is pica (specific cravings). The progesterone hormone in pregnancy causes the lower esophageal sphincter to relax. With the addition of pressure on the stomach due to the enlarging uterus, this results in reflux and tendency for heartburn. To increase absorption of nutrients, your gastrointestinal tract also reduces its motility and is a common cause of constipation.
Urinary tract activity increases
Since there is increased blood volume and cardiac output, this causes increased blood flow to the kidneys which leads to increased glomerular filtration rates (GFR). The bladder also relaxes which increases its capacity of retaining urine. This increases the risk of urinary tract infection. Although the bladder may be able to retain more urine, the enlarging uterus will increase pressure on the bladder causing you to have to urinate more.
Skin changes appearance
If you have ever been pregnant before, you will know that there is hyperpigmentation (darkening) of the umbilicus and nipples. The midline in the abdomen (linea nigra) also becomes prominent. The increased circulation and high levels of the hormone estrogen can also cause spider nevi and palmar erythema.
Musculoskeletal (muscle and skeletal) changes
The laxity in ligaments increase and can contribute to back pain and dysfunction in the pubic symphysis. There is also a shift in posture where there is lumbar lordosis leading to the typical gait in pregnant mothers.
What Is Edema During Pregnancy?
Edema is another name for the swelling of body parts due to fluid retention. It is not a disease but rather an indication that there is an underlying issue. Generally, edema can be divided in two types:
- Pitting edema
- Non-pitting edema
In pregnancy, most women experience pitting edema. This occurs when there is an indentation on the swollen area after you apply pressure to it. Hence, the name “pitting”. It is most commonly seen in the lower limbs especially the extremities. In some cases, it can also affect other parts of the body such as your hands, arms, fingers, and more. While it is common during pregnancy, it is also a symptom for several serious health issues. This is why if you notice pitting edema, you should see your doctor to rule out any harmful underlying issues. To understand more about the difference between pitting and non-pitting edema, check out this diagram!
Why Are My Ankles and Feet Swelling in My Second Trimester
For most, swelling of the feet and ankles are considered to be normal during pregnancy. It is due to the collection of excess fluid and changes in your blood chemistry that causes fluid to move into the tissue. Another change during pregnancy is the pressure from the growing uterus on your pelvic veins and inferior vena cava (a large vein that carries returning blood from lower limbs to the heart). This pressure slows the return of blood from the lower limbs causing pooling of blood and forcing fluid from the veins into the tissues in your feet and ankles. To understand more about this phenomenon, check out this video:
The degree of ankle and feet swelling can be worse for women who have excessive amniotic fluid or are carrying more than one fetus as the pressure on the pelvic veins and inferior vena cava is much higher. After you have delivered your baby, the swelling should gradually resolve as your body starts to rid itself of the excessive fluid. This is why some women urinate or sweat more the first few days after childbirth.
When Should I See My Doctor for Swelling in My Feet and Ankles?
Up to 80% of all pregnant women will experience pitting or non-pitting edema during their course of pregnancy. It most commonly affects the feet and ankles. If you are suffering any of the following symptoms, you should consult your doctor as soon as you can.
- Increase blood pressure
- Frothy urine – This indicates that there might be protein in your urine
- Reduced movements of the baby
- Severe headaches
- Blurry vision
- Heartburn that does not improve despite taking medication such as antacids (easily found over the counter)
- Facial swelling
- Puffiness around the eyes
- Excessive or sudden swelling of the feet, ankles, or hands
If you have one leg that is significantly much more swollen than the other along with other symptoms such as redness, pain, and tenderness in your calf or thigh, this could mean that there is a blood clot and you should seek medical attention immediately.
What Your Doctor Might Assess
One of the things that your doctor or nurses might look into is your daily caloric intake and if you are having a well-balanced diet consisting of all food groups (specifically protein intake). The optimal calorie and protein intake differs for every pregnant woman and should be calculated based on their weight and activity level. Once there is an established dietary pattern, nutritional counseling becomes more effective. Total weight gain and total serum albumin level will also be monitored to ensure that there are no deficiencies.
What Can I Do to Reduce the Swelling?
Remember that the following steps are meant to help you but should not substitute medical advice. For both you and your baby’s sake, you should always consult your doctor to ensure that you are only experiencing normal swelling and rule out serious underlying conditions. Some of the ways that can help you reduce swelling during pregnancy are:
- By lying on your side when you are lying in bed to reduce the pressure on your veins
- Put your feet up to help encourage venous return. You can put a stool under your desk too if you are at work.
- Try to keep off your feet as it can increase swelling.
- Try not to cross your legs or ankles while you are sitting as it may interrupt with venous return.
- Stretch your legs frequently and flex your foot as this helps contracts your calf muscles. The muscles will be able to help you “pump” some of the returning blood back to your heart via the inferior vena cava. You can also rotate your ankles or wiggle your toes.
- Try not to remain standing or sitting for a long time. Take short breaks and walk around to prevent your blood from pooling in your feet and ankles.
- Wear comfortable shoes that can accommodate your feet swelling.
- Avoid wearing tight socks
- Wear maternity support stockings. You can put them on before getting out of bed to prevent blood pooling around your feet and ankles.
- Stay hydrated, exercise regularly (low impact exercises), and stick to a healthy diet.
While it may be depressing that your feet and ankles now look unsightly, remember that it will all be worth it in the end! Once you deliver our baby, the edema will gradually subside!