“Don’t let pregnancy worry you”

In her interview with Bauerfeind life, Dr. med. Anya Miller, President of the German Society for Lymphology (DGL), explains how she supports the treatment of pregnant patients suffering from lipedema or lymphedema. In her practice for skin and venereal diseases, phlebology and lymphology, she cares for many edema patients and knows their fears when it comes to pregnancy.

life: Dr. Miller, can lipedema or lymphedema be triggered by pregnancy?

Dr. Miller: It’s theoretically possible. Lipedema usually develops during phases of hormonal changes. This can be the case after puberty and quite often during menopause – and, in principle, it can also happen during pregnancy. I do have patients who say they started noticing changes after pregnancy. But there are no studies or evidence confirming that pregnancy poses an increased risk for developing lipedema or lymphedema.

The onset of primary lymphedema can basically be at any stage in life, depending on where the genetic defect is located. Frequently, these are phases where the lymphatic system is briefly subjected to major strain, such as sports, inflammation or, of course, pregnancy. Overall, the risk of pregnancy being a trigger for chronic edema is quite low.

How do hormonal changes during pregnancy affect patients with an existing edematous disease?

Dr. Miller: There’s a big difference between lipedema and lymphedema. In patients suffering from lymphedema, the edema may increase over the course of the pregnancy. In the height of summer, too, when it’s really hot, a pregnant patient can have more severe problems. I don’t know of any patients where the lipedema suddenly progressed during pregnancy. A problem is that, despite their often young age, a significant proportion of lipedema patients is also obese. If pregnancy occurs in combination with obesity, the risk of edema developing will also be higher. You could carefully consider lymphatic drainage in a patient suffering from lipedema who also gets problems with lymphedema after getting pregnant and gaining weight.

What other adjustments do you make when treating pregnant patients suffering from edema?

Dr. Miller: I support my patients closely to ensure we keep the edema under control. I mainly take care of patients with primary lymphedema who become pregnant or want to become pregnant. We get the physical therapist involved early on to provide treatment adapted to the specific requirements during pregnancy. Effective compression stockings are essential. Luckily, we have great options nowadays. My motto is therefore: don’t let pregnancy worry you if you suffer from edema!

What needs to be considered when it comes to compression therapy?

Dr. Miller: Lymphedema patients should mainly be prescribed flat-knit products. For lipedema patients, we sometimes have to find individual solutions. The garments are used in the problematic areas and where there is painful fatty tissue. If it goes up to the hip, the patient can wear a knee-high stocking and a 3/4-length or full-length pantyhose. Using a thigh-high stocking would be inappropriate because the area around the hip should be included. With all pregnant edema patients, we have to make sure that the compression garment is always adapted to the growing belly circumference.

What needs to be considered when prescribing compression products to pregnant women?

Dr. Miller: The prescription must specify that the patient is pregnant. A special panty area for the baby bump can be added. Compression pantyhose are super stretchy in the belly area and breathable. During pregnancy, the pantyhose can also be replaced, if needed.

Does compression also affect the pregnant woman’s well-being?

Dr. Miller: Compression reduces pain for lipedema patients. That’s why they’re generally happy to wear compression products during pregnancy, too. In cases of lymphedema, which is not usually painful, compression makes sure that major edema increases in the legs are prevented. Patients can still wear their clothes and fit into their shoes. This is a reason why the “seasoned lymphedema patient” will continue to use her compression products.

Do you recommend lymphatic drainage during pregnancy?

Dr. Miller: Lymphatic drainage is possible during pregnancy, just not deep abdominal drainage. In general, lymphatic drainage has the pleasant side effect that it feels really relaxing, allowing pregnancy-related problems, such as muscle tension and discomfort to be treated at the same time.

Images: Bauerfeind, Thomas Lebie