Varicose Veins & Pregnancy: Everything You Need to Know

Overview

Varicose veins and spider veins (or ‘thread veins’) are more common than you think! Around 30% of the adult population will have thread veins at some point during their lifetime, while women are more likely to develop varicose veins than men¹. So, if you think you have varicose veins or thread veins, you’re not alone.

There’s also a strong link between pregnancy and the development of varicose veins¹.

Many women suffer with varicose veins during pregnancy, with some studies reporting that as many as 70% of women are affected².

Why do varicose veins and spider veins manifest during pregnancy?

To understand why varicose veins and spider veins manifest during pregnancy, it’s important to know what both conditions are.

Varicose veins are caused by valves inside the veins failing and allowing blood to flow in the wrong direction. When the one-way valves that help the blood go from the feet back up to the heart stop working, the blood goes back down towards the feet which increases the pressure inside the vein, causing it to bulge outwards.

Thread veins can also be a result of the same valve failure but are tiny, prominent veins just below the skin’s surface. They do not bulge like varicose veins and carry fewer symptoms.

Based on the above, there are a few things that can cause varicose veins and spider veins to develop during pregnancy. While genetics play a role, it’s not the only reason. There are other important factors that also affect pregnant women, including:

• When you’re pregnant, more blood needs to circulate around your body to support the growing baby. This increase can be a burden on the blood vessels and their valves and can sometimes result in reflux of blood within the veins and cause varicose veins to develop.
• As the uterus expands during pregnancy, this can hinder the blood returning from the legs to the heart. It also puts a strain on the veins in the legs, causing them to increase in size and sometimes develop varicose veins and thread veins.
• The hormonal changes that occur during pregnancy can cause veins to become enlarged, often leading to the development of varicose veins and thread veins^1,2.
• Weight gain and reduced physical activity are common during pregnancy and can also contribute to the development of varicose veins.

Where on the body can they occur?

Thread veins (or ‘spider veins’) appear mostly on the legs during pregnancy, with a higher likelihood than varicose veins.

It’s common for women to have both thread veins and varicose veins during pregnancy as they are symptoms of the same condition. Varicose veins can affect the vulval area, though this is less common and can be linked to varicose veins in the legs.

Are they painful?

Just like most other people who suffer with varicose veins, the symptoms can vary during pregnancy, from little to no discomfort, to legs that feel heavy and achy. Other symptoms can include a burning sensation, restlessness, throbbing and itchiness.

Managing varicose veins

Do varicose veins disappear by themselves postnatally?

Varicose veins that develop during pregnancy can often completely improve in the 12 weeks that follow giving birth. However, in some women varicose veins will remain after pregnancy and then will only be fully resolved with treatment³.

Are varicose veins dangerous for pregnancies?

It’s rare for varicose veins during pregnancy to cause complications like venous ulcers, thrombophlebitis (superficial clot in a varicose vein) or DVT. In most cases, varicose veins and spider veins that progress during pregnancy, tend to improve after the baby has been born.

Therefore, varicose veins are best treated conservatively during pregnancy by wearing compression stockings, doing regular exercise and maintaining a healthy diet.

What are the best ways to manage varicose vein pain during pregnancy?

There are a few things you can do to relieve the pain that varicose veins cause during pregnancy.

Measures to relieve symptoms include:

1. Regular exercise like swimming or taking a brisk walk every day.
2. Wearing compression stockings. This also improves blood circulation and helps to relieve any pain or throbbing.
3. Avoid standing or sitting in one position for extended periods of time.
4. Elevating the leg to improve blood flow.

Prevention

Is there a way to prevent varicose veins during pregnancy?

Unfortunately, the factors that contribute to the development of varicose veins during pregnancy such as increased blood volume, increase in uterine mass and hormonal changes are normal physiological responses to pregnancy.

Don’t worry, though. There are things you can do to reduce their impact, including leg elevation, exercises such as swimming, as well as wearing of compression hosiery which can reduce the discomfort that’s common with varicose veins⁴.

Treatment

Can varicose veins be treated during pregnancy?

Varicose veins are not routinely treated during pregnancy as we do not have safety data on the medications used during the procedure.

There is also a small increased risk of Deep Vein Thrombosis (DVT) during pregnancy. Due to these factors, most specialists would treat pregnant patients conservatively, and therefore there is no safety data on the impact of EVLA treatment on pregnant women.

As varicose veins can resolve fully after pregnancy and small risks of DVT in the 6-8 weeks after a pregnancy we do not advocate treatment at Veincentre until 3 months post childbirth.

When is the safest time to receive treatment?

We do not advise to undertake consultation and treatment until three months post-childbirth.

If a consultation is attended prior to a subsequent pregnancy, a further scan following pregnancy will need to take place prior to any treatment being carried out to ensure there has been no new abnormal refluxing veins during or after pregnancy. This second scan will be free of charge.

Varicose veins are usually treated with endovenous laser ablation (EVLA) and foam sclerotherapy or avulsions. However, it is important to note that mothers who are breastfeeding would need to discard any milk produced in the first 24 hours after foam sclerotherapy treatment to avoid passing the drug to the baby. It is imperative to ensure enough milk has been expressed to cover this timeframe.

References

1. DeCarlo C, Boitano LT, Waller HD, Pendleton AA, Latz CA, Tanious A, et al. Pregnancy conditions and complications associated with the development of varicose veins. J Vasc Surg Venous Lymphat Disord. 2022;10(4):872-8 e68.
2. Ismail L, Normahani P, Standfield NJ, Jaffer U. A systematic review and meta-analysis of the risk for development of varicose veins in women with a history of pregnancy. J Vasc Surg Venous Lymphat Disord. 2016;4(4):518-24 e1.
3. Belcaro G, Dugall M, Luzzi R, Ippolito E, Cesarone MR. Postpartum Varicose Veins: Supplementation with Pycnogenol or Elastic Compression-A 12-Month Follow-Up. Int J Angiol. 2017;26(1):12-9.
4. Abdul Sultan A, Grainge MJ, West J, Fleming KM, Nelson-Piercy C, Tata LJ. Impact of risk factors on the timing of first postpartum venous thromboembolism: a population-based cohort study from England. Blood. 2014;124(18):2872-80.