Should I be concerned about swollen feet?
Valencia Stephens, MD, is an OB/Gyn at Banner Ironwood Medical Center in San Tan Valley, Ariz.
Question: I am 35 weeks pregnant with my first baby, and by the end of the day, my feet are so swollen that I cannot wear my normal shoes. My grandmother tells me that I may have toxemia, but when I talked with my doctor, he said that my swelling isn’t anything to worry about. Who is right?
Answer: Both are right, to an extent. Your family is worried about a condition called preeclampsia, which represents about 5-8 percent of pregnancies. In the past, we referred to it as toxemia. It was diagnosed as the triad of high blood pressure, proteinuria (protein in the urine), and edema (swelling).
It was a very important cause of morbidity and mortality (disability and death) in women in the U.S. prior to modern times and is still one of the top causes of morbidity and mortality in less developed countries. But in the last decade, we have made some advances in what we know about preeclampsia versus normal pregnancy changes. Preeclampsia is now diagnosed based on the presence of high blood pressure and proteinuria.
Though excessive swelling may be present with preeclampsia, it is not an essential component for diagnosis. Swelling (especially in the lower extremities) is a normal consequence of the enlarging uterus which causes impeded blood flow from the lower extremities. Other visible signs of this back up include hemorrhoids and varicose veins. Swelling is present in virtually all pregnancies in the third trimester to some extent; and when seen without high blood pressure and proteinuria, it does not represent preeclampsia.
Hopefully your doctor did an examination that included a urine dip for protein and measured your blood pressure prior to telling you that everything is alright. If that is the case, stick with the opinion of the one wearing the white coat, and good luck to you!
Reviewed January 2011