Swelling in pregnancy: what’s normal and what’s not

Almost every pregnant woman notices swelling at some point in her pregnancy, whether it is in her feet, legs, hands, or face. It’s important to know that while most of the time this swelling is not a problem, there are a few signs you should not ignore.

While the onset varies from woman to woman, many will start to notice some swelling in their feet and legs (especially down by the ankles) sometime in the second trimester. This usually becomes even more obvious as your due date nears. This happens for a few reasons: hormones make the blood vessels more relaxed so blood pools more easily, and the growing uterus blocks the blood flow from the lower part of your body on the way back up. These both add up to puffier legs and feet. In addition, gaining weight and having more blood in your circulation contributes.

Dealing with this kind of swelling is usually pretty straightforward: elevate your feet often above the level of your heart to help the blood flow back up more easily, wear supportive shoes and tight-fitting stockings (compression socks work wonders at keeping the blood from pooling in your legs), and don’t go overboard on high-sodium foods.

Keep in mind that some type of leg swelling is definitely not normal. If you have noticed any of the following types of swelling, you should let your doctor or midwife know immediately:

• Sudden swelling in one leg only, or very uneven swelling
• Pain, tenderness, or redness at the swollen area
• Pain in one leg while walking

These can all be signs of something known as a deep vein thrombosis (DVT), or a blood clot. This is when blood clots in a vein and the swelling that results is because blood cannot drain appropriately. DVT can be a life-threatening emergency if part of it breaks off and goes to the lungs. This is called a pulmonary embolism and can result in death. Luckily, DVT can usually be safely treated in pregnancy with medicine with no effect on the health of your baby.

Swelling can happen elsewhere too, such as in your hands and face. Usually these are related to normal pregnancy changes (weight gain and carrying extra blood and fluid in your body), but occasionally these can be something more. If you notice very sudden onset of swelling in your hands or face or they are accompanied by other signs of preeclampsia, you should let your doctor know. While they are not “officially” considered signs of preeclampsia, they definitely will raise your doctor or midwife’s level of suspicion, and they may do some tests to rule this out.

Reviewed by Dr. Jen Lincoln, April 2020