During pregnancy women can develop varicose veins due to circulatory and hormonal changes which support the fetus during development. Due to the growing fetus, blood volume increases 40% or more and is mostly in the veins causing further engorgement of the veins. Hormonal changes throughout the pregnancy also lead to further relaxation of smooth muscle cells which may cause more venous insufficiency. Finally, the mass effect of the expanding uterus as the fetus grows, causes partial obstruction of the venous outflow from the legs to the pelvis, leading to engorgement of the veins in the legs. As the pregnancy progresses the veins may become more distended and painful. Varicose veins which develop during pregnancy usually improve immediately after decompression of the pelvis with the delivery, and continue to do so over the course of the next several months as the blood volume returns to normal and hormonal changes revert. The risk of progression of venous insufficiency increases with each subsequent full term pregnancy. If significant varicose veins or other signs of venous insufficiency are identified early in the child bearing years, proactive investigation and appropriate treatment as is advised before pregnancy rather than allowing the disease to progress unchecked.
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