Pregnancy and Lymphedema
Is there a relationship between pregnancy and lymphedema?
Limited research is available on how the two conditions impact each other, and even less evidence-based information is available for treatment options. An international group of healthcare professionals have made it their mission to help change this for clinicians and patients.
What did we do?
An extensive systematic literature review of available research was completed by the team to uncover all the possible physiological (chemical or organ system) and biomechanical (body or skeletal system) changes an individual may undergo during pregnancy and the postpartum period. The team then had to analyze the findings to compare them with what is known about the lymphatic system and lymphedema to see which changes may increase swelling during the pregnancy. The team also held small focus groups in Wales and the United States with healthcare practitioners to uncover the training received, experience with previous patients, and the educational needs of these clinicians with evaluating and treating lymphatic dysfunction during pregnancy and the postpartum period. Next, the team obtained case studies from four individuals with different experiences to begin looking at the patient perspective on their experience and what they would like to see changed related to the care they received. This led to an international survey study of healthcare providers on their education, experiences, limitations, and needs for this population. Lastly, the team has launched an international survey study on the experiences of individuals with lymphedema and/or lipedema during pregnancy and the post-partum period.
What did we uncover?
There are several routes where the hormone and body shape changes that occur with pregnancy can increase the burden on the lymphatic system, resulting in increased swelling in the tissues. These changes (refer to the figures below) can worsen swelling for individuals already diagnosed with lymphedema and can cause the initiation of swelling for others. There is limited research on how the different aspects of Complete Decongestive Therapy (CDT) should be applied or modified for pregnancy or the post-partum period. The healthcare practitioners from the focus groups and the survey study did not have much experience working with these two populations and felt they needed more education to be confident in providing appropriate care. The four individuals all experienced worsening or the onset of swelling during the pregnancy, with more pronounced changes with additional pregnancies. Even though the swelling did reduce or resolve with the three individuals, all felt there could be improvement in the care they received.
The first figure of the flow chart shows the systems that where found to be impacted during pregnancy that have a relationship with the lymphatic system and swelling. The key is that if there is an imbalance in any portion of this flow chart, swelling can occur or increase in the tissues. The second set of figures, the box and image of a pregnant individual, show how the lymphatic system may become compressed or compromised due to biomechanical or body changes that occur during pregnancy.
What is next?
Individual Experiences: The team has launched a short international survey study for individuals with lymphedema and/or lipedema to further investigate the experiences during pregnancy and the postpartum period. The survey is available in multiple languages (English, Welsh, Spanish, French, Italian, German, Dutch, Hebrew, Chinese, and Turkish). Please share this survey with others to provide more voices for this study. The team hopes the results of this study will assist in the development of educational materials and courses for healthcare practitioners and individuals.
Want to learn more:
The team provided a webinar on the research to date for the Lymphedema Education and Research Network (LE&RN) on August 14, 2024. you may visit the LE&RN website or click on the image to view the webinar.
Meet our team:
Shelley DiCecco, PT, PhD, CLT-LANA, is the owner of LymphEd, LLC
Ria Lewis-Strange, BSc(Hons), is a physiotherapist with Lymphoedema Wales Clinical Network and a National Cellulitis Specialist
Diana Mehrez, BSc, BN, is a nurse specialist with Lymphedema Wales Clinical Network and the Clinical Lead in Cardiff and Vale.
Kathryn Downing, PT, DPT, is a US physical therapist
Kennya Palacios, PT, DPT, CLT-LANA
Several Doctor of Osteopathic Medicine students from the Philadelphia College of Osteopathic Medicine:
Madelyn France, Nayleis Gonzalez, Gem Johnson, Halle Mastronardo, and Brittany Nichols
