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Bloating in late pregnancy

by Peg Plumbo

question
I am in my 36th week of pregnancy and I am suffering from water retention. I have seen my doctor and have normal blood pressure and haven't had any headaches or any other problems that could indicate pre-eclampsia. Do you have any suggestions?

answer
It sounds like you understand the link between bloating (swelling or oedema) and pre-eclampsia, especially in a first pregnancy. If you have no other signs (protein in the urine, pitting oedema of the legs - where you can indent the area over the shin bone - or symptoms such as headaches, rapid or excessive weight gain, visual changes, abdominal pain or dizziness), then the bloating may well be just one of the common discomforts of pregnancy.

Pregnant women experience dilation in the blood vessels, especially in the lower extremities, and ‘pooling’ of the blood, which causes oedema. Sodium and water retention occurs and there is a shift of fluids out of the cell into the spaces between cells. This is why it used to be customary to ask women to reduce their salt intake during pregnancy. Now we recommend that you salt food to taste - but stay away from heavily cured meats and salty snacks.

Blood volume doubles during pregnancy and women generally are more thirsty, so more fluids are consumed. While these changes are normal and necessary, they mean a lot more fluid is circulating.

The best way to deal with excess fluid is not to restrict it but to mobilise it. Keep it from staying in areas that cause the most discomfort, such as in the legs, feet, fingers and abdomen. Assisting kidney function is one way of doing this. Rest and fluids are the two best ways to help the kidneys get rid of excess fluid. You want the filtration rate to increase, so it is important to rest on your left side as much as possible, not just a night, but for several 30 minute periods throughout the day. Keep your legs elevated whenever possible. Don’t cross your legs. The right kidney suffers more during pregnancy because of its lower position, so moving the baby's weight off it helps it to work more efficiently. In addition, any time you rest with your feet up, pressure is reduced on the inferior vena cava and the iliac veins, so the blood can get back up and not pool in the extremities. Renal blood flow is improved as well. Drink at least six to eight glasses of water, juice or milk every day. This keeps the kidneys functioning properly.

When you're not resting, exercise. Women who exercise have fewer symptoms of the common problems associated with pregnancy, including swelling. It seems to redistribute the retained fluids. Brisk walking is the best form of exercise for pregnancy (I know it’s difficult to do anything briskly in your last month).

In addition, you may find that wearing support tights designed for pregnancy is helpful. Make sure you are fitted properly and wear them according to the directions. They even feel good after you’ve had the baby. Avoid constricting clothing.

Make sure you see your doctor every week until the baby is born. Swelling could precede other symptoms of pre-eclampsia.

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