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Varicose Veins During Pregnancy: Causes, Risks and When to See a Vascular Surgeon
Close to 40 percent of pregnant women develop varicose veins at some point during pregnancy. For most, the swollen, twisted veins that show up
Medically Reviewed by
Dr. Paul Hanna, DO, RPVI
Board Certified Vascular Surgeon
Close to 40 percent of pregnant women develop varicose veins at some point during pregnancy. For most, the swollen, twisted veins that show up on the legs are an uncomfortable side effect of carrying a baby, not a medical emergency. But pregnancy also raises the risk of a much more serious vein problem, deep vein thrombosis, and it isn’t always obvious to a patient which one she’s dealing with.
Understanding the difference matters. Ordinary pregnancy varicose veins, a common form of vein disease, are usually harmless and tend to fade on their own after delivery. A blood clot in a deep vein is not something to wait out. Here’s what actually causes varicose veins during pregnancy, how to manage them safely, and the specific signs that mean it’s time to call a vascular surgeon.
Pregnancy changes the body’s circulation in a few specific ways, and each one puts extra strain on the veins in the legs.
The biggest driver is hormonal. Progesterone, which rises sharply during pregnancy, relaxes the muscular walls of blood vessels so the body can handle a growing blood supply. That same relaxation effect makes it harder for leg veins to push blood back up toward the heart against gravity. Researchers have also found estrogen and progesterone receptors in the saphenous veins, the veins that most often become varicose, which may explain why hormonal shifts affect these particular veins so directly.
Blood volume itself also increases substantially during pregnancy, adding more pressure inside veins that are already working harder. On top of that, as the uterus grows it presses on the pelvic veins and on the inferior vena cava, the large vein on the right side of the body that carries blood from the legs back to the heart. That added pressure backs up into the leg veins and makes them more likely to bulge and twist.
Genetics plays a role too. A woman is more likely to develop varicose veins during pregnancy if her mother or grandmother had them. Carrying more than one pregnancy raises the risk further. Research shows women who have already had one pregnancy have a higher rate of varicose veins than women who haven’t, and women with multiple pregnancies have the highest rate of all. Symptoms also tend to get worse with each pregnancy that follows. This general family and lifestyle pattern lines up with what we see in what causes varicose veins outside of pregnancy as well.
Diet and body weight play a smaller but real role as well. Carrying excess weight adds pressure on leg veins the same way a growing uterus does, and a diet low in fiber and water while high in sodium can make swelling worse, which compounds the discomfort even when it isn’t the root cause of the vein changes themselves.
Interestingly, for most women who develop pregnancy varicose veins, the symptoms start early. Somewhere between 70 and 80 percent of affected women notice signs within the first trimester, often within just two or three weeks of becoming pregnant.
The most obvious sign is visible, and it’s usually what sends a patient looking for answers. Veins on the calves, thighs, or sometimes the vulva become swollen, raised, and twisted, often with a blue or purple color under the skin.
Beyond appearance, most women describe a heavy or tired feeling in the legs by the end of the day. Aching, throbbing, and tenderness are common, along with itching directly over the affected vein and occasional leg cramps, especially at night. Swelling in the legs and ankles frequently comes along with it, since fluid retention and vein pressure tend to build at the same time during pregnancy.
Symptoms typically get worse after standing or sitting for long stretches and tend to improve with rest or elevation. Some women barely notice their varicose veins at all beyond the visible bulging. Others find the aching genuinely disrupts daily activity, which is a reasonable reason to bring it up at a prenatal visit even if nothing about it is dangerous.
For the large majority of women, no. Ordinary varicose veins are a circulation nuisance, not a threat to the pregnancy or to long term health. But pregnancy is also a period when the body’s clotting system becomes more active, since it needs to be ready to limit blood loss during delivery. That same shift raises the risk of deep vein thrombosis, a blood clot that forms in one of the deep veins of the leg.
The numbers here matter. Pregnant women are up to five times more likely to develop a deep vein thrombosis than women who aren’t pregnant, and that higher risk continues for roughly six weeks after delivery. Among pregnant and postpartum women who do develop a deep vein thrombosis, about 82 percent of cases occur in the left leg.
The reason is mostly anatomical. The right iliac artery crosses over the left iliac vein near the pelvis, and the growing uterus adds even more compression at that same spot. Certain factors push the risk higher still, including a personal or family history of blood clots, a cesarean delivery, carrying more than one baby, being 35 or older, and extended bed rest or immobility.
A deep vein thrombosis is not the same thing as a varicose vein, and the two can look confusingly similar at first glance. This is exactly the distinction that matters most for a pregnant patient to understand.
Ordinary pregnancy swelling and varicose veins tend to build up gradually and affect both legs to some degree, even if one looks worse than the other. A deep vein thrombosis usually looks and feels different. Watch for swelling that comes on in one leg only, especially if it develops over a day or two rather than gradually over weeks.
Pain or tenderness that isn’t explained by an injury, calf pain that worsens with walking, and skin that feels warm to the touch or looks red or discolored on just one leg are the signs that separate a clot from routine pregnancy circulation changes. For a fuller rundown, our guide to DVT symptoms in the leg covers what to watch for in more detail. Some women also notice difficulty walking normally on the affected side, which on its own is a reason to call your provider that same day rather than waiting to see if it improves.
If a clot breaks loose and travels to the lungs, it becomes a pulmonary embolism, which is a medical emergency. Sudden shortness of breath, chest pain that worsens with a deep breath or cough, a rapid heartbeat, or coughing up blood call for immediate emergency care, not a wait and see approach.
It’s worth noting that ordinary leg swelling is extremely common in pregnancy on its own, so swelling by itself is not a reliable red flag. It’s the combination of one sided swelling with pain, warmth, or redness that should prompt a same day call to your provider.
Most pregnancy varicose veins can be managed with simple changes rather than medical treatment, and the goal during pregnancy is comfort, not a permanent fix.
Travel deserves a specific mention. Long car rides or flights mean sitting still for hours, which is exactly the kind of prolonged immobility that raises clot risk on top of ordinary vein strain. On any trip over a couple of hours, plan to get up and walk the aisle or stop at a rest area, and do simple ankle circles or calf raises while seated if you can’t move around.
None of these steps will make existing varicose veins disappear overnight, but together they tend to reduce the aching, swelling, and heaviness that come with them. It’s also worth saying plainly that the research on compression stockings during pregnancy is mixed. Some studies haven’t found a clear difference in leg swelling between women who wear them and women who don’t, even though many providers, including our own, still recommend them because patients frequently report feeling better with them on.
Procedures like sclerotherapy, laser therapy, and vein stripping are effective at closing off or removing problem veins, but they’re generally not performed during pregnancy. The main reason is practical rather than about any specific danger of the procedures themselves.
Most pregnancy varicose veins improve substantially within three to four months of giving birth, once blood volume returns to normal and the uterus is no longer pressing on the pelvic veins. Treating a vein that’s likely to shrink on its own doesn’t make sense for most patients, so vascular surgeons typically wait and reassess after that postpartum window has passed.
Some research has looked at oral phlebotonic medications for relieving varicose vein symptoms during pregnancy, and early results are promising for symptom relief. But safety data for use during pregnancy is still limited, so these aren’t something to start without a direct conversation with your OB first.
If a vein causes ongoing pain that isn’t manageable with the steps above, that’s a conversation worth having with your OB and a vascular surgeon during pregnancy rather than waiting. Treatment decisions are always individual, and persistent symptoms don’t have to be endured simply because delivery hasn’t happened yet.
For most women, pregnancy varicose veins shrink noticeably within three to four months after delivery as hormone levels and blood volume return to their pre-pregnancy baseline. Leg swelling tends to improve even faster, often within the first few weeks postpartum.
If varicose veins are still present and bothersome once that window has passed, that’s the right time to explore treatment. Options range from continued conservative care to sclerotherapy, laser treatment, or catheter based procedures that close off the problem vein, depending on its size and location. A vascular surgeon can walk through which approach fits your specific veins once you’re no longer pregnant or breastfeeding.
Veins do sometimes get worse with each additional pregnancy, so a vein that resolved after your first child may take a different course after your second or third. That’s a normal pattern, not a sign anything went wrong.
Most pregnancy varicose veins don’t need a specialist visit right away, but a few situations call for one.
Reach out promptly if a varicose vein starts bleeding, if the skin over it develops an open sore, or if the vein becomes suddenly hard, warm, and painful to the touch, which can signal a superficial clot. Any one sided leg swelling paired with pain, warmth, or redness needs same day medical attention because of the deep vein thrombosis risk described above. And if varicose veins are still present and uncomfortable three to four months after delivery, that’s a reasonable time to schedule an evaluation rather than continuing to manage symptoms on your own.
Our vascular surgery team can confirm what’s actually happening in the vein with an ultrasound, rule out a clot, and lay out realistic varicose vein treatment options once treatment becomes appropriate. Getting evaluated doesn’t commit you to any procedure. It just gives you accurate information instead of guesswork during a time when guesswork feels riskier than usual.
No. Varicose veins are a change in the mother’s circulation and don’t affect the baby directly. They’re uncomfortable for the mother but not a sign of a pregnancy complication on their own.
Yes, and it actually helps. Walking and other light, pregnancy safe activity improve circulation and can ease the heaviness and swelling that come with varicose veins.
For most women, yes. They typically shrink substantially within three to four months after delivery as blood volume and hormone levels return to normal.
Generally yes, and many providers recommend wearing them throughout the day, removing them at night. Check with your OB if you have any circulation conditions that might change that advice for you specifically.
Ordinary varicose vein discomfort tends to build gradually, affect the legs generally, and ease with rest or elevation. Sudden swelling in just one leg, along with pain, warmth, or redness, is different and should be evaluated the same day.
Cleveland Clinic, “Varicose Veins During Pregnancy”
Centers for Disease Control and Prevention, “Understanding Your Risk for Blood Clots with Pregnancy”
Devis P, Knuttinen MG, “Deep venous thrombosis in pregnancy: incidence, pathogenesis and endovascular management,” PMC, National Institutes of Health
Mayo Clinic, “Deep vein thrombosis (DVT): Symptoms & causes”
Smyth RM, Aflaifel N, Bamigboye AA, “Interventions for varicose veins and leg oedema in pregnancy,” Cochrane Database of Systematic Reviews, PMC
Mayo Clinic, “Varicose veins – Diagnosis and treatment”
Dr. Paul Hanna is a board-certified vascular surgeon with specialized fellowship training in complex vascular interventions and minimally invasive endovascular techniques. He serves as Director of Vascular Surgery and General Surgery at South Florida Multispecialty Medical Group, with over a decade of experience treating vascular conditions affecting the limbs, aorta, and peripheral arterial system.
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