In the early pregnancy, you may beam from the inside out with bright, rosy skin and hair that brilliantly glistens for days. Then, one day, something takes the wind out of your prego-beauty sails — you look down and don’t even recognize the two extremely puffy cankles beneath you.

Unfortunately, swelling falls into that perfectly normal category of pregnancy side effects. In fact, most expecting mamas experience it. But why?

Let’s look at what causes swelling during pregnancy and offer some tips to beat the bloat with comfort and confidence.

And, a note of caution: There are a few instances in which swelling during pregnancy is concerning. We’ll also explain when it could be a sign of a more serious health condition.

During pregnancy, your body does some pretty herculean things, and there’s a lot that, well, increases. One of them is the sheer amount of fluid in your body. While pregnant, your total body water volume can increase by up to 8 liters— that’s over 33 cups!

Meanwhile, your plasma volume leaps 30 to 50 percent, which means your total blood volume increases as well.

So, where does all that fluid go? Good question.

Some of the water stays within your cells to help them function. The rest accumulates outside of your cells to enhance oxygen delivery, clear waste, and control electrolyte flow.

The increase in plasma is in response to the growing needs of the placenta and your maternal organs, as your blood volume increases to deliver all that your baby needs to develop.

As your little one inches closer to birth in the third trimester, your blood volume reaches its peak. Hint: That’s why your swelling (among other slight unpleasantries) can peak around this time.

But that’s not all.

The massive increase in body fluids during pregnancy is coupled with increasing sodium levels. And most of us have seen the effects of what a little too much takeout pizza can do.

Sodium affects how your body absorbs and processes water. Even the slightest rise in sodium may cause you to feel the power of the “puff.”

It’s completely normal to shed a little tear the day your rings and favorite heels don’t fit anymore (sigh). A little gradual swelling in your fingers, legs, ankles, and feet throughout pregnancy is part of the journey.

You may find that your swelling tends to worsen toward the end of the day. This is because the extra fluid in your body can gather in the parts of your body farthest from your heart. A hotter, humid day or a lot of standing can contribute to some normal swelling, too.

Moving into the second and third trimesters, more pressure from your little one’s growing size — in addition to more blood volume — may further affect blood flow in your legs, ankles, and feet, causing you to experience even more swelling.

Tips to relieve normal pregnancy swelling

Sometimes, swelling may be as inevitable as that supersonic sense of smell and burning indigestion that you take in stride with the pure joys of pregnancy. However, here are a few things that you can do to help prevent or ease it.

  • Elevate your feet at a level above your heart throughout the day, as this helps the fluid circulate back to your heart.
  • Drink more water to flush extra fluid and sodium out of your body.
  • Wear compression stockings to improve circulation, especially if you’re taking a long flight.
  • Avoid being outdoors in very hot and humid weather.
  • Take frequent breaks to elevate your feet when standing for long periods.
  • Avoid heels and wear comfortable, breathable, and supportive shoes.
  • Eat more foods with potassium, such as bananas and avocados, to flush out sodium and increase urine production (yes, even more).
  • Limit high salt foods, such as prepackaged meals, fast food, and chips.

We know every mama bear wants to know when to panic. The answer? Never. Panicking only boosts your emotional and physical stress. Instead, feel empowered by learning when to call your OB-GYN or midwife about swelling.

The two most concerning conditions during pregnancy that can cause swelling are preeclampsia and a blood clot.

First thing to remember: These conditions aren’t common, but the risk is real during pregnancy. Therefore, it’s important to be aware of them.

Secondly, swelling associated with these conditions is different than the normal, gradual swelling you may experience over the course of your pregnancy.

Here’s how the swelling is different.


Preeclampsia only affects about 5 percent of pregnant women, usually only after the 20th week. The following are three main symptoms of this disorder:

  • high blood pressure
  • protein in the urine
  • edema (a fancy word for swelling caused by excess fluid in the body)

Labs may also show abnormalities in liver enzymes and lower than normal platelet levels.

This relatively rare condition can have devastating consequences for mom and baby if not treated immediately, so it’s important to be aware of the symptoms — and swelling is one of the major ones.

Significant swelling in your hands, face, or around your eyes that comes on suddenly or gradually becomes worse should alert you to call your OB-GYN. If your swelling appears “pitted” — meaning when you push on your skin, an indentation remains — this is also concerning.

In preeclampsia, swelling might be accompanied by a persistent headache, vision changes, abdominal pain, and sudden weight gain. If you have any of these symptoms, call your OB or midwife immediately. They may advise you to go to your nearest emergency room.

Blood clots

Pregnancy is a risk factor for blood clots in the leg, thigh, or pelvis called deep venous thrombosis (DVT). A 2017 review states that pregnancy alone increases a woman’s risk of DVT fivefold. The risk is consistent throughout every trimester and even up to 12 weeks after delivery.

DVT is a serious condition during pregnancy and warrants immediate treatment, as it may cause a pulmonary embolism (PE), which can be fatal.

To protect mom and baby, it’s important to catch a DVT by knowing the symptoms. Swelling affecting only one leg is a big one.

Swelling related to DVT often occurs with other symptoms affecting the same area, such as:

  • significant pain
  • tenderness
  • redness
  • warmth to the touch

If you have any of these symptoms, call your OB or midwife immediately and follow their direction.

Reducing normal pregnancy swelling is nice but not always possible — and that’s OK.

It’s more important to do what you can to prevent serious complications like preeclampsia and blood clots. Again, though, prevention isn’t always possible and early recognition is key. That said, here are some tips that might decrease your risk.

How to lower your risk of preeclampsia

A limited number of studies have demonstrated proven ways to prevent preeclampsia.

While supplementation with vitamins C and E has been researched as a possible preventive measure, a study in 2007 concluded that antioxidant supplementation with these vitamins shouldn’t be recommended for preeclampsia prevention during pregnancy.

Moreover, while some studies have demonstrated a possible connection between prenatal physical activity and a reduced preeclampsia risk, more studies are needed to confirm this relationship.

It’s most important to know your risk factors so your obstetrician can monitor you more closely if necessary.

Some risk factors for preeclampsia include:

  • chronic high blood pressure before pregnancy or during a previous pregnancy
  • kidney disease before pregnancy
  • personal or family history of preeclampsia
  • having overweight or obesity
  • having a multiple gestation pregnancy (more than one baby)
  • being over age 40
  • being pregnant with your first baby
  • pregestational and gestational diabetes
  • being of African American ethnicity

For women with a history of preeclampsia, low-dose aspirin has been cited as an effective secondary prevention strategy. Aspirin to prevent preeclampsia in women with a high risk but no personal history is still under debate.

How to lower your risk of blood clots

Like preeclampsia, preventing blood clots during pregnancy, childbirth, and the 3-month period afterward starts with knowing your risk factors, such as:

  • personal or family history of blood clots
  • personal family history of a blood clotting disorder
  • history of a cesarean section, also known as a C-section
  • immobility or long-term bed rest
  • certain pregnancy or childbirth complications
  • having diabetes, heart disease, or a lung condition

Your OB or midwife can work with you to help reduce your risk by developing a personalized prevention plan. Here are some easy everyday things you can do, too:

  • drink plenty of water
  • move your legs or get up at least every 1 to 2 hours if you’re sitting a lot
  • exercise as recommended by your doctor
  • use compression socks or stockings if recommended by your doctor
  • take prescribed medications as directed

If growing feet coincide with your growing belly, you’re certainly in very good company. There’s a normal level of swelling that affects most expecting ladies.

Normal swelling can peak in the third trimester, affecting the legs mostly. Some simple elevation and R&R with a big glass of water may be all that you need to calm your cranky cankles.

In rarer cases, swelling is a sign of something more serious. If swelling affects only one leg and is accompanied by pain, redness, or warmth, a blood clot could be a concern, and you should call your doctor.

If you experience sudden or gradually worsening swelling in your face, around your eyes, or in your hands accompanied by high blood pressure, call your doctor immediately. This could be a symptom of preeclampsia, which requires immediate treatment to protect you and baby.