From the Guidelines
Leg pain in pregnant women should be promptly evaluated for deep vein thrombosis (DVT), particularly if it is localized to the left leg, as DVT is more common on the left side due to compression of the left iliac vein by the right iliac artery and the gravid uterus 1. When managing leg pain during pregnancy, it is essential to consider the potential for DVT and pulmonary embolism (PE), which can be life-threatening conditions.
- Key factors to consider in the clinical evaluation include:
- Left leg presentation
- Calf circumference difference of 2 cm or more
- First trimester presentation
- A clinical decision rule considering these variables can help identify patients at low risk for DVT, but this requires validation in prospective studies 1. For immediate relief of leg pain, pregnant women can try:
- Elevating their legs when sitting or lying down
- Wearing compression stockings
- Staying physically active with gentle exercises like walking or swimming
- Applying cold or warm compresses to painful areas Over-the-counter pain relievers like acetaminophen (Tylenol) can be used at standard dosing (500-1000mg every 6 hours, not exceeding 4000mg daily) if approved by their healthcare provider 1. It is crucial to avoid NSAIDs like ibuprofen during pregnancy and to maintain proper hydration (8-10 glasses of water daily) and a balanced diet rich in magnesium and potassium to help prevent muscle cramps. Regular stretching, especially of the calves before bed, may reduce nighttime leg cramps. If leg pain is severe, persistent, accompanied by swelling, redness, or warmth, or if the patient experiences chest pain or difficulty breathing, they should seek immediate medical attention as these could indicate a blood clot 1.
From the Research
Leg Pain in Pregnant Women
- Leg pain is a common complaint among pregnant women, with various underlying causes such as sciatica, leg cramps, and varicose veins 2
- A study found that 22.1% of pregnant women experienced sciatica, 18.2% experienced leg cramps, and 9.4% experienced varicose veins 2
- The same study found that a greater proportion of women with sciatica (79.3%) or varicose veins (71.5%) sought help for their condition compared to women with leg cramps (46.7%) 2
Risk of Venous Thromboembolism
- Pregnant women are at a higher risk of developing venous thromboembolism (VTE), which can lead to deep vein thrombosis (DVT) and pulmonary embolism (PE) 3, 4, 5, 6
- Anticoagulant medications are commonly used to prevent and treat VTE, and newer anticoagulants have been introduced in recent years 3, 4, 6
- The use of anticoagulants can help prevent the postthrombotic syndrome (PTS), a chronic condition that can occur after DVT 5
Treatment and Prevention
- Anticoagulation therapy is the cornerstone of treatment for VTE, and the choice of anticoagulant depends on various factors such as renal and liver function, underlying diseases, and patient preferences 4, 6
- Elastic compression stockings (ECS) can be used to counteract venous hypertension and reduce leg edema, and may also help prevent PTS 6
- Further research is needed to examine the health-seeking behavior and treatment use of pregnant women who experience lower extremity problems, in order to facilitate safe and effective maternity care 2