Edema or swelling of the legs and arms is a normal sign of pregnancy . The body changes occurring during this time are to be blamed for the symptom, while gravity is responsible for making it more evident in the extremities . Your feet and ankles are more susceptible to swelling while other affected areas may include the knees, hands and fingers. Most women experience the symptom during the third trimester, but it can occur in the first and second trimesters as well. Usually, there is nothing to worry about swelling while pregnant; but, in rare cases it may indicate serious underlying problems and complications.
What causes swelling in pregnancy?
The increasing body fluid volume to provide your baby with oxygen and necessary nutrients is often the main cause behind the swelling . Your body tissues retain the extra fluid, causing swollen feet, ankles and hands at the end of the day.
What are the risk factors for swelling while pregnant?
- Warm weathers
- Standing or walking for a long time
- Rising estrogen hormone levels (especially in early pregnancy)
- Potassium deficiency 
- Too much sodium intake
- Carrying twins
- Excessive caffeine consumption 
- High blood pressure in pregnancy 
Types of edema in pregnancy
Two types of swelling can be noticed during this time:
- Pitting edema: Characterized by a small indentation left by a little pressure applied on the swollen area 
- Non-pitting edema: The common form of swelling where no dimple or indentation can be seen when pressure is applied .
Preventing swollen feet, ankles and hands during pregnancy
The following preventive measures can also come useful to manage minor puffiness:
- Avoiding standing up over long periods
- Avoiding crossing your legs when sitting down 
- Drinking plenty of water to flush out the excess sodium and accumulated waste materials 
- Avoiding wearing tight strapped shoes or heels, opting for comfortable soft shoes
- Avoiding tight elastic stockings and socks
- Keeping your feet elevated above the level of your heart when resting, especially at night (popping them up using cushions or pillows can help) 
- Doing light ankle and feet exercises
- Trying to lie on your left as much as possible to help in circulation 
- Avoiding going out on hot and humid days 
How to reduce swelling during pregnancy?
The symptom usually goes away on its own after delivery. Here are some treatment measures that help with its management:
- Putting on waist-high maternity stockings in the morning before getting out of bed as the swelling is least noticeable after the long rest 
- Going for a short walk 
- Standing in a pool can provide temporary relief as the water pressure helps to compress the swollen tissues (there is no scientific evidence in favor of this treatment) 
- Bed rest (for severe ankle and feet swelling)
- Swimming for a short time (safety of swimming in pregnancy)
- Getting a foot massage helps to treat the problem by relaxing the muscles and tissues 
- Doing pre-natal yoga
- Placing an Ice pack or a cold compress on the swollen area 
- Soaking your feet in Epsom salt
Foot exercise to relieve swollen feet and ankles
Here is a simple exercise you can do while sitting down or even standing :
- Bend and stretch your right foot, repeating 30 times
- Then, rotate the foot in a circular motion eight times to the right and eight times to the left
- Now, repeat these two steps with your left foot.
Dietary tips for swelling in pregnancy
- Following a diet containing five portions of fresh vegetables and fruits
- Including moderate amounts of lean protein (e.g. eggs, beans, pulses and lean meat) to every meal 
- Following a diet consisting of garlic, onion, celery, parsley, apples and watercress for improving circulation and allowing the kidney to work better
- Avoiding pre-packaged, processed foods and salty snacks
- Including plenty of vitamin C (including potatoes, tomatoes, strawberries and melons) and vitamin E rich foods (sweet corn, wheat germ, cashews and almonds) in your diet
- Following a diet rich in potassium-rich foods such as bananas 
- Avoiding consuming too much salt as sodium accumulation is often associated with pregnancy-related swelling 
When to call the doctor?
- Sudden swelling of the hands and feet (might indicate preeclampsia) 
- Swelling accompanied by pain and redness
- Puffiness along with red streaks running down your legs 
- Swelling that lasts for over 24 hours even after taking rest, keeping the feet elevated
- Puffiness affecting the arms and face (might indicate high BP or preeclampsia) 
- Swelling along with rapid weight gain
- Swelling in one leg (unilateral swelling) 
- Swelling and tenderness in the pelvic area (might indicate an ectopic pregnancy) 
- Puffiness accompanied by symptoms like severe headache, dizziness, blurred vision, upper right abdominal pain and vomiting (might indicate complications like preeclampsia, eclampsia and toxemia)
Swelling ICD-9 and ICD-10 codes
ICD-9 codes of 782.2, 784.2, 786.6 and 789.3  are used for indicating swelling while its ICD-10 code is R22 .
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