Pregnancy and Primary Lymphedema

INTRODUCTION

A pregnant patient, who also has primary lymphedema, needs special precautions.

"Having PLE should not prevent you from raising a family if you want one. With the appropriate precautions, and common sense, you too can have a family ."

Since primary lymphedema (PLE) develops most commonly in women and affects their feet and legs, it is only natural that questions arise about pregnancy in women with PLE. These women, very wisely, are concerned about what to expect during pregnancy and how to manage it. I have worked with many PLE patients during pregnancy and have researched so I can effectively help my patients and be prepared to answer their questions and suggest precautions.

Here are precautions that can help you achieve these goals:

YOU CAN DO IT!!

Unless you have other health issues that make pregnancy risky having primary lymphedema should not prevent you from having a family. However, it is essential that your healthcare team work in close cooperation to help you achieve the goal of producing a healthy baby while protecting your affected leg(s).

INFORM YOUR HEALTHCARE PROVIDERS

• At your first visit, inform your obstetrician (or midwife) that you have primary lymphedema or are at risk of developing it. Be prepared to provide them with information about “What is lymphedema.”
  Because PLE is a hereditary condition, if you have not developed it yet, inform your doctors that you at risk and the symptoms to be looking for.
• If you have PLE, inform your therapist as soon as you know you are pregnant. Your lymphedema therapist should be an important part of your prenatal team by providing appropriate treatment, necessary advice, and recommended changes in your treatment and self-care routines.
• Arrange a phone consultation between your obstetrician (or midwife), and your lymphedema therapist, so that they can work together to ensure that you have a healthy pregnancy.

BE EXTRA CAUTIOUS

A cellulitis infection is a danger to you at any time. During pregnancy, an untreated infection is a threat to you and to your baby. Discuss this potential with your doctor and be prepared with emergency antibiotics.

BE AN INFORMED PATIENT

Learn about how your body changes and ways in which the stresses of pregnancy can affect lymphedema.
Also, learn the danger signs that indicate you need to see your doctor as soon as possible.

BE PREPARED

As your pregnancy progresses, you may need help with your lymphedema self-care and possibly other routine activities. The time to recruit, and train, a helper or helpers is early in your pregnancy before this need becomes critical.

• Manual lymph drainage (MLD) is recommended throughout your pregnancy. MLD helps control the swelling and keeps you more comfortable. Additional treatments may also be necessary as the pregnancy places more stress on your body.
• Continue your self-massage program. Maintaining self-massage on a regular basis is very important, yet as your pregnancy progresses, it will become increasingly difficult
  for you to reach your legs and feet, this is the time for your “helper” to begin aiding with this routine.
  Also, as your pregnancy progress, you should ask your therapist for guidance in modifications of your abdominal breathing and massage for abdominal clearance.
• Compression is a must throughout your pregnancy. This routine can also need some modification to accommodate your increasing size. The exception to this is if, for any reason, your doctor instructs otherwise.
• If you have been wearing compression panty hose before your pregnancy continue to wear them, unless you are told otherwise. Before investing in maternity compression hose, check with your therapist as to what level of compression is recommended.
• If you have been wearing thigh high compression hose, be certain they do not bind. If this is a problem, ask your therapist for recommendations. Toward the end of your pregnancy, you may need help in getting these stockings on and off; here is another opportunity for your helper.
• Bandaging. Even if you do not normally bandage, you may find it beneficial during pregnancy. This is because bandages have the advantage of being adjustable to accommodate changes in your leg size and the amount of compression that is needed. Bandaging your legs as your belly size increases can be challenging, if not impossible, to do by yourself. Again this is an opportunity for your helper
• 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, you are going to need some help. 
• Walking 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 and be sure to drink lots of water while during this so that you do not become dehydrated. Seek your doctor’s guidance in starting a walking routine 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. Check with your doctor before heading for the pool, some doctors are concerned about how the chemicals in public pools might affect your body during pregnancy. Do not go into water that is warmer than 94 degrees.
• Bed Rest. You may find that in order to control the swelling you need to spend time on bed rest with your feet and legs elevated. This allows nature and gravity to help reduce the swelling. This is another area of your life where planning ahead and lining up some help can make this easier to manage.
• Prenatal Visits. It is very important that you keep all of your prenatal visits. One important reason for this is because some serious complications can develop without major symptoms.
• Weight Control.  Follow the recommendations of your healthcare team as to how much weight it is healthy for you to gain. If you have a sudden weight gain (without binge eating) report this immediately to you doctor or midwife because this can be a sign of 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. This condition is characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and vision changes are other important symptoms; however some women with rapidly advancing disease, report few symptoms.
• The hypertension (high blood pressure) 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 lymphedema. Because of the added risk associated with primary lymphedema, your doctor may recommend monitoring of your blood pressure at home between visits.
• If you develop any symptoms of preeclampsia, consult your doctor immediately. Your lymphedema therapist should also be notified because it may be necessary to modifying your bandaging and compression routines so they do not place excess strain on your heart and other body systems.
• By following these precautions your increase your chances for a healthy pregnancy with a happy outcome.

ACKNOWLEDGEMENTS

“Pregnancy and Primary Lymphedema” was written by Doris Laing, LMT, CLT-LANA and published inthe book  “Voices of Lymphedema.” It is reprinted here with permission of the publisher, LymphNotes 2007.

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Category: Living With Lymphedema Updated: 2014-11-01