Women frequently ask, “How do I prevent varicose veins during my pregnancy?” or “What shall I do about my varicose veins now that I am pregnant?” These are good questions that deserve proper answers.

Women who have the genetic predisposition to develop varicose veins, in other words, a family history of varicose veins, often develop them and suffer from them during their first pregnancy. A common story is that the woman developed mild and perhaps few varicose veins with her first pregnancy only to have the varicosities become much worse and more difficult to tolerate during her second pregnancy. Sometimes the varicosities markedly diminished after the first delivery but following the second pregnancy remain and progress over time.

Varicose veins in pregnant women usually worsen with each pregnancy, as do the symptoms of pain, fatigue, restlessness, cramping and itching of the leg. There is also an increased risk for acute clotting of the varicos‐ icosities, a condition called acute thrombophlebitis, during pregnancy. This inflammatory condition adds to the discomfort and there is always the concern that extension of the clot into the deep veins of the leg may lead to more serious and even life-threatening conditions.

Several factors are at play during pregnancy which promote the development of varicose veins –

1)Circulating hormones of pregnancy have a direct influence on the veins and their valves that cause both to become more distensible and less strong

2)The enlarging gravid uterus in the pelvis exerts direct pressure on the large veins of the abdomen and pelvis making it more difficult for the venous blood to drain from the lower extremities.

3)Increased volume of blood in the circulation of pregnant women results in simply more blood in the legs for the veins to contain.

At Surekha Varicose Veins Clinic, we advise women with varicose veins who plan to become pregnant to have the varicose veins treated PRIOR to the pregnancy. With the minimally invasive procedures available today from qualified and experienced vein doctors, the varicose vein problem should be dealt with pre-emptively. There is no place for what doctors told patients in the past, “Finish having all your children and then have your varicose veins fixed”. Why suffer with varicose veins through one or more pregnancies if the whole problem could be avoided? Minimally invasive ablation procedures carry minimal risks, can be done easily and offer quick return to normal activities. Future pregnancies become much more comfortable and the risk for acute clotting of the varicosities (acute thrombophlebitis) is much reduced.

If a woman with varicose veins finds herself pregnant or develops varicose veins after becoming pregnant, so called conservative therapy should be followed. “Conservative therapy” means daily wearing of prescription grade graduated compression stockings whenever out of bed, exercise and elevation whenever possible

The compression stockings that one finds as ‘over the counter’ product at medical stores are almost worthless when compared to the benefits of prescription grade graduated compression stockings that are fitted to the patient after measurements are taken. Brands such as Sigvaris, Bauerfeind and others are examples of the graduated compression stockings that come in different sizes and are selected after careful measurements have been made.

The term “ graduated” refers to the tapering effect of the pressure or tightness of the stockings such that the greatest compression is at the ankle and lower leg and less as the stocking goes higher. This creates a pressure differential in the leg that promotes the proper drainage of the blood and helps to overcome the problems in the veins and circulation that occur with pregnancy. The stockings should be applied in the mornings (as soon as possible after getting up in morning) and only be removed when going to bed at night.

In summary, if a woman has varicose veins and desires to have children, she would be well advised to have the varicose veins eliminated with the modern minimally invasive treatments.

If a woman with varicose veins finds herself pregnant, she should begin daily wearing the good quality compression stockings as soon as the pregnancy test is positive.

If varicose veins first develop with a pregnancy, conservative therapy, which is the conscientious daily use of compression stockings, exercise and elevation whenever possible, should be followed. Then the varicose vein problem should be addressed between pregnancies to avoid future difficulties and complications.