Venous and non-venous symptoms in pregnancy – how might compression help?

Commonly, compression therapy in pregnancy is prescribed to prevent and treat oedema, thrombosis or to possibly prevent varicose vein progression. Especially in the first and third trimester, patients are at risk of developing oedema. In general, pregnancy and childbirth present the greatest risk of thrombosis in women caused by venous insufficiency. Using repeated measures via CIVIQ (Chronic Venous Disease Quality of Life Questionnaire) score throughout pregnancy, an Italian study showed that regular wearing of compression stockings significantly improved quality of life compared with participants who refused to wear stockings. Furthermore, results indicated that wearing compression stockings during pregnancy led to reduced symptoms of chronic venous insufficiency (CVI) in a dose-dependent manner compared to another group undergoing compression therapy in a less compliant manner.

Most studies analysing the effect of compression therapy in pregnancy focused on improvement of venous insufficiency, but what about other pregnancy-related physical impairments such as nausea and vomiting? About 50% to 80% of pregnant women suffer from nausea and vomiting in pregnancy (NVP), which understandably has a negative impact on quality of life, as there is no suitable therapy to date. Possibly, high levels of human chorionic gonadotropin (hCG) in the first trimester cause NVP since both NVP and hCG levels are correlated. The hCG-induced increase of progesterone lessens the efficacy of smooth muscles, that are also part of the oesophagus, stomach and intestine, which could be a cause for the NVP. As well, NVP is correlated with fewer stillborn children and higher birth-weight, indicating that high levels of hCG in the early pregnancy improve the outcome of pregnancy. Another positive effect of NVP is a more conscious lifestyle of the pregnant women, as they take more care of themselves and thereby protect their unborn children.

Induced by her own experiences with her patients, Dr Mendoza initiated a study assessing the intensity and development of nausea during pregnancy. The study focused on participants between gestation week 8 and 18, because nausea peaks between week 7 and 10 and decreases thereafter. The participants were randomised into two groups. In a cross-over design, one group received compression therapy for two weeks followed by two weeks without compression, while the other group conducted the sequence vice versa. All participants who completed the study wore the stockings 5 to 8 hours per day. Of those, 80% recommended compression therapy because they experienced significantly less nausea, vomiting, reduced leg pain as well as less mental and physical discomfort. Overall, there was a significantly higher quality of life measurable as well as an improvement of leg-related symptoms under compression therapy (see MOH Focus).

The presentation was followed by a brief discussion, which revealed consensus among the participants that compression therapy during pregnancy is an easy and safe way to reduce symptoms of venous insufficiency as well as nausea and vomiting, and thus greatly improves the quality of life of pregnant women. If you missed this interesting talk, you are welcome to watch the full session.

Take Home Messages:

• Compression therapy during pregnancy is indicated for the prevention and treatment of chronic venous insufficiency (CVI) symptoms, such as varicose vein progression, oedema and thrombosis, but also for nausea and vomiting in pregnancy (NVP)
• Compression therapy led to an increase in quality of life in an Italian study (decreased CIVIQ scores):
• • Daily: decrease by 13.5 (±9.6) points from 48.8 (±15.7) to 34.4 (±11.5)
  • Twice a week: decrease by 10.7 (±11.3) points from 43.6 (±16.1) to 32.9 (±8.8)
  • No compression: increase from 36.6 (±15.6) to 40.9 (±17.7)

• Compression therapy led to significantly reduced NVP and increased leg-related quality of life (CIVQ) in a study with participants between gestation week 8 and 18, initiated by Dr Mendoza:
  • Total NVP QoL increase from baseline by ~30% with vs. ~20% without compression
  • Total CIVIQ decreased by ~10% from baseline with compression vs. increase by 3% from baseline in participants without compression
  • 80% of the participants recommended compression therapy