Pregnancy During Summer

How to maximize comfort and minimize risk during summer

Having practiced obstetrics here in Los Angeles since 1988, I have learned that pregnant women are often miserable during the summer. They get more leg swelling, more fatigue and exhaustion, increased perspiration and often just feel lousy. These problems are due to hot weather aggravating the normal effects of pregnancy hormones on metabolism and on salt and water retention.

Pregnant women normally have a higher metabolic rate, higher resting heart rate, and higher body temperature than non-pregnant. They "run hot." They have less reserve to tolerate the two extremes of summer -- which are heat, and increased fluid intake and losses.

The following steps can help to prevent heat and sun-related problems:

  • Avoid direct mid-day sun, because pregnant women are more prone to sunburn than non-pregnant.
  • Use high SPF lotion, 30 to 45, especially if you are fair-skinned.
  • Drink one 8 oz. glass of water or fluid replacement solution (such as Gatorade) for each hour you are outdoors in hot weather. Total liquid intake during summer should be six to eight glasses of liquid per day.
  • Avoid vigorous outdoor exercise during the hot hours of the day. As with marathon runners, fluid losses can be so rapid, that by the time you feel thirsty, you are actually already seriously dehydrated.
  • At the first sign of any weakness, fatigue, dizziness, lightheadedness or excessive thirst, get indoors, lie down, and drink some cool water or electrolyte replacement. If you do not feel better soon, call your doctor. Avoid ice-cold liquids, and do not take a shower right away or you could pass out.

Normal vs. abnormal leg swelling

Leg swelling (called edema) may be a common problem during pregnancy, but if the second half of pregnancy occurs during the summer months, the degree of leg swelling can increase dramatically. This makes many women miserable, and also can heighten their concern that they are developing a complication.

Normal leg swelling during pregnancy (physiologic edema) is notable for the fact that it is usually resolved in the morning upon awakening, and becomes progressively worse during the day. Also, both legs tend to be equally swollen. The legs may be tight, uncomfortable or achy, but usually there is no significant pain.

Signs that suggest a possible medical complication include: swelling in one leg much worse than the other, significant pain in one or both legs, significant swelling that appears suddenly (within a few days), swelling that occurs in the hands and/or face as well as the legs, or swelling that seems much worse in the morning than the day before. The two medical conditions that can cause swelling that we worry about are DVT (blood clot in the leg veins) and toxemia (also called pre-eclampsia).

Normal swelling during pregnancy follows gravity. Standing makes it worse in the lower extremities. Lying down, especially while partially elevating the legs, makes it better.

Additionally, some pregnant women get mild swelling of the hands. The hands may feel "tight." Usually this type of swelling is worse in the morning, and better by the end of the day. However, hand numbness, pain or weakness may signal a possible complication.

The following can help you deal with uncomfortable swelling of the legs:

DON'T

  • Wear constrictive clothing, especially around the waist.
  • Stand in one place too long. Walking is preferable to standing.
  • Eliminate all salt from your diet. It's true that excessive salt intake can aggravate swelling, but this is rarely the reason for the swelling. Furthermore, salt contains traces of iodide, an element essential for the health of the fetus, and extreme salt restriction can be dangerous to your unborn baby. Salt intake reduction is advisable, just not complete restriction.
  • Take any medication, herb, vitamin or other natural remedy with diuretic properties. There are some powerful, "natural" diuretics available, and they can cause loss of precious bodily minerals which could endanger the fetus.

DO

  • Contact your doctor right away if your swelling seems to meet any of the criteria above for possibly being a danger sign.
  • Drink 6-8 glasses per day of plain water. Drinking lots of water can flush some extra salt out of your body and actually help to reduce swelling.
  • Try to lie down on your left side, for 30-60 minutes daily, either at the end of the workday, or during lunch if possible. Alternatively you can lie on your back, reclining at about 45 degrees, and then elevate the legs as well by placing a small pillow under them.
  • Place a soft object such as a rolled up towel or blanket under your mattress at the foot of the bed. This will keep the legs elevated while sleeping.
  • Wear comfortable soft shoes with low heels, and possibly invest in one pair of shoes 1/2 size larger than you normally wear.
  • Try to engage in mild frequent exercise such as walking or swimming 2-3 times per week. If outdoors, try to exercise early in the morning when it's cool.
  • Remove your rings if your fingers seem to be tight. Rarely a ring needs to be cut off to remove it.

One last piece of advice.

If you really want to avoid these problems, avoid getting pregnant between Thanksgiving and New Year's. These babies have due dates in August and September (which for some strange reason are typically the busiest months in the baby business!).

Summer is the season that most of us look forward to. If you are pregnant, however, summer poses additional stresses and risks that need to be dealt with. Following the above advice can help you to minimize the effects of the summer heat and help you to ensure a safe pregnancy for you and your baby, and a more comfortable one for you.

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