Pregnancy and Primary Lymphedema

Pregnancy and PLE need special precautions.

Introduction

Primary lymphedema (PLE) most commonly develops in females during their teens. As these young women mature, and are ready to start a family they have questions about the interaction of pregnancy and PLE

Can I have children?

Yes. Unless you have other health issues the make pregnancy risky, PLE should not prevent you from having a family; however, there are special precautions that you should follow. Ideally your healthcare team will work in close cooperation to help you achieve the goal of protecting your affected leg(s) while producing a healthy baby.

• Make your obstetrician (OB), or midwife, are aware that you have lymphedema. If your healthcare provider is not familiar with lymphedema, you (or your lymphedema therapist) need to educate him or her about this condition.
• Work closely with your lymphedema therapist throughout your pregnancy. There may need to be modifications in your lymphedema treatment.
• You should learn about pregnancy complications that can become worse because of the lymphedema.
• Be prepared. As your pregnancy progresses, reaching your feet and legs will become more difficult. You need to be prepared by arranging for your partner, or a caregiver, to help with your lymphedema home-care program.

The Risk of Inheriting Lymphedema

According to Professor P. Mortimer and Dr Sahar Mansour, in their article Lymphoedema and Pregnancy, the following are the risks of having the baby inherit lymphedema.

• The baby is at an increased risk of inheriting the lymphedema if the mother has a family history of lymphedema and is affected with swelling in both feet and legs.
• Even if a baby inherits the gene for lymphedema, it does not mean to say he or she will be as severely affected as the parent. Indeed, the lymphoedema may be very mild despite a severely affected parent.
• The baby is at low risk of inheriting lymphedema if the affected parent has no family history of lymphedema, has unilateral swelling in one of the lower limbs, or has swelling that is not in the lower limb.

The Swelling of Pregnancy

In a normal pregnancy the cardiovascular system increases the blood output from the heart by at least 50%. This means that most pregnant women, have some swelling of the feet and legs particularly in the third trimester toward the end of the pregnancy. Pumping this additional fluid, and the other strains of pregnancy, place an added stress on the heart and other body organs.

When the expectant mother has PLE, this swelling may start sooner and to be more severe; however, the PLE swelling should be manageable. The pregnancy induced swelling usually disappears soon after the baby is born; however, the PLE will continue to require treatment.

Weight Control

Follow the recommendations of your healthcare team as to how much weight it is healthy for you to gain. However, if you have a sudden weight gain (without binge eating) report this immediately to your OB or midwife because this can be an indication of preeclampsia.

Preeclampsia

Preeclampsia is a rapidly progressive serious complication of pregnancy that affects both mother and child. It usually occurs after the 20th week (late second trimester) or in the third trimester.

Preeclampsia is characterized by hypertension (high blood pressure) and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are other important symptoms; however, some women with rapidly advancing disease report few symptoms.

The hypertension of preeclampsia puts an added strain on the heart and other body systems. To minimize strain on the heart, it may be necessary to modify the compression used to treat your PLE. Because of the risk associated with PLE, your doctor may recommend monitoring of your blood pressure at home between routine visits.

If you develop hypertension, consult with your physician immediately and medication may be prescribed. In addition your lymphedema therapist may modifying your bandaging and compression routines so they do not place excess strain on your heart and other body systems.

Continued Massage During Pregnancy

This massage helps to control swelling and to make you more comfortable. Additional massage treatments may be necessary as the pregnancy places more stress on your body.

• Your therapist will perform manual lymph drainage (MLD) as necessary.
• You will perform self-massage as long as possible
• Your caregiver will perform simple lymphatic drainage (SLD) as instructed by your therapist when you can no longer reach your feet and legs.

Compression Hose

• Compression is a must throughout pregnancy; however, this may need to be modified to accommodate your increasing size. As always, follow your doctor’s instructions.
• If you have been wearing compression panty hose before your pregnancy continue to wear them, unless you are told otherwise; however before investing in maternity compression hose, check with your therapist as to what level of compression is recommended.
• Thigh high compression hose are an alternative. Some styles have a silicone band around the top to hold them in place. An alternative is to use a specialized adhesive lotion, made by the stocking manufacturer, to help hold the stockings in place.
• Toward the end of your pregnancy, you will probably need help in getting these stockings on and off.

Bandaging

• Even if you do not normally bandage, you may find it to be beneficial during pregnancy. This is because bandages have the advantage of being adjustable to accommodate changes in your legs and the amount of compression that is needed.
• Bandaging your legs as your belly increases in size can be difficult (if not impossible). This is another place when a caregiver can help you.

Skin Care

Pregnancy usually causes abdominal stretch marks and your OB or midwife may offer suggestions to minimize this scarring. It is also important to continue your proper lymphedema skin care — plus taking care of your feet and toenails. Again, your caregiver can help.

Exercise

Exercise is very important for your general health, to promote a healthy pregnancy, and to control the swelling of your lymphedema. Walking is usually the preferred exercise. If you have not been active or exercising, start a walking routine under your doctor’s guidance and modify it as your pregnancy progresses.

Water exercises are excellent throughout your pregnancy. Toward the end of the pregnancy, as walking becomes harder, exercising and walking in the water become even more beneficial. Research has shown that the benefits of water exercise during in pregnancy usually produces a 10-15% improvement of heart and kidney function. Avoid water above 94 degrees F (34 degrees C ). Gentle exercises below this temperature are comfortable and help to relax muscles

Bed Rest

You may find that in order to control the swelling you will need to spend time on bed rest with your feet and legs elevated. This allows nature and gravity to help reduce the swelling.

Is an Epidural Safe During Labor and Delivery?

"I have primary lymphedema and I'm wondering if it is safe to have an epidural during labor?"  This question has come up several times and now, thanks to Dr. Dweck, we have an answer. It is, "I spoke with the head of OB anesthesia at my hospital and as long as there is no sign of infection on the back (L4-L5) where epidural is placed, there is no contraindication to epidural. That being said, I agree with the use of compression garments during labor and delivery. Keep in mind also, many women in the later weeks of pregnancy will suffer with generalized pedal edema due to pregnancy, so I presume primary lymphadema may worsen at this time." [5]

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Category: Living With Lymphedema Updated: 2010-02-01