Why do legs cramp when pregnant and what to do?

Unfortunately, pregnancy is not only a joyful anticipation of the birth of a baby, but also a number of unpleasant moments. For example, toxicosis, heaviness, cramps in the legs during pregnancy are not uncommon. Cramps can bother both during the day and at night, and the muscles can remain hypersensitive for a long time after that. How to prevent cramps and is it possible to eliminate them? What is the reason for their appearance?

Doctors say: leg cramps during pregnancy occur at any stage. Sometimes they do not have a clear cause and are directly related to the "interesting" situation, but in some cases they can be a sign of a disease that requires immediate intervention by a medical specialist. Let's try to understand this issue in more detail. [ 1 ]

Epidemiology

According to statistics, nine out of ten women periodically experience leg cramps during pregnancy. In 60% of cases, the discomfort occurs after a long walk or when staying in an upright position for a long time. And in 30% of women, cramps appear without any obvious reasons.

Most often, the problem is detected in the second half of pregnancy – approximately 20-22 weeks.

Causes leg cramps in pregnancy

Most pregnant women experience leg cramps due to the following reasons:

• Microelement instability in the body, lack of magnesium, potassium or calcium, or vitamin B ₆. Here is what can cause such instability:
  • 1st trimester – frequent vomiting, toxicosis, inability to properly absorb vitamins and microelements or lack of their sufficient intake (for example, with a complete lack of appetite);
  • II trimester – active intrauterine development of the baby and the associated high need of the mother’s body for microelements;
  • throughout pregnancy – poor nutrition, taking certain medications (for example, diuretics).
• Anemia. When the hemoglobin level drops, the oxygen supply to the muscles is disrupted, which causes periodic spasmodic contractions, which are especially disturbing in the legs (without a specific connection to the time of day).
• Hypodynamic stagnation of blood flow. Due to insufficient motor activity of a woman, stagnation processes occur in the circulatory system.
• Varicose veins. Spasmodic muscle contractions are a concern as a result of venous blood stagnation – they are found mainly at night or closer to evening.
• A drop in blood glucose levels. A state of energy starvation, when the flow of glucose into the blood is disrupted, can also cause leg cramps. Such troubles occur mainly at night or closer to the morning.
• Inferior vena cava compression syndrome. Starting from the 20th week of pregnancy, the enlarged uterus begins to put pressure on the inferior vena cava. This causes a slowdown in blood flow in the legs, swelling and cramps. Interestingly, cramps in this situation bother the pregnant woman if she lies on her back or on her right side.
• Dehydration: Drinking small amounts of fluid throughout the day can cause leg cramps during pregnancy.
• Incorrectly selected footwear, hypothermia of the feet, prolonged standing or walking.

Risk factors

Risk factors that can increase the risk of leg cramps during pregnancy include:

• excessive thinness, or, conversely, excess body weight;
• a sharp change in the intensity of physical activity;
• poor nutrition and poor water balance;
• liver disease, thyroid disease, frequent nervous shocks and breakdowns, diabetes.

Pathogenesis

Pathogenetic mechanisms of muscle contraction, as well as the processes of regulation of this reaction by the nervous system are very complex and depend on the different content of certain ions in the cell and outside it. Any failure and imbalance can cause cramps, and the main reason is considered to be a disorder of mineral metabolism.

This is what this disorder is associated with:

• with increased need for minerals during pregnancy;
• with toxicosis, frequent vomiting, diarrhea;
• with eating disorders, lack of appetite, predominance of certain foods in the absence of others, etc.;
• with taking medications (especially in the absence of supervision by a doctor).

Most often, mineral metabolism disorders are associated with a deficiency of such components as potassium, calcium, magnesium and vitamin B ₆.

• Potassium plays a special and important role in intracellular metabolism processes. With prolonged or frequent vomiting or diarrhea, with chaotic or long-term treatment with diuretics, a deficiency of this microelement may develop. Potassium deficiency is often caused by excessive coffee consumption, but during pregnancy this problem is most often irrelevant, since coffee consumption during this period is usually greatly limited, or the drink is completely abandoned. Few people know, but the absorption of potassium is impaired by a lack of magnesium, another important microelement.

Potassium can be obtained from such products as dried apricots, bananas, beans, broccoli, milk, melon. The average daily human requirement for potassium is about 4.5 g.

• Calcium is a microelement, the normal absorption of which is impossible without the presence of magnesium and vitamin D ₃. Increased need for calcium occurs during periods of stress and pregnancy. Products containing oxalic acid (for example, sorrel and rhubarb, spinach, etc.) or phosphates (caviar and canned fish, egg yolks, hard cheese, cocoa and soda) disrupt calcium absorption. Insufficient consumption of protein foods also disrupts the absorption of the microelement, but normal intake of iron in the body promotes good absorption of calcium in the gastrointestinal tract.

Where can the body get calcium? There is plenty of it in greens, beans, nuts, figs, cottage cheese, hard cheese.

• Magnesium is especially necessary during pregnancy, as the need for the microelement increases many times during this period. Caffeine and excess potassium accelerate the removal of magnesium from the body. A woman's body will require more magnesium against the background of a high-protein diet and the use of hormonal drugs.

Magnesium deficiency can be replenished by adding seeds, nuts, beans, any greens, carrots, and onion greens to your diet.

• Vitamin B6 deficiency _itself does not cause cramps. However, vitamin deficiency makes it difficult for cells to absorb and assimilate magnesium. Pyridoxine acts as a kind of conductor that facilitates the penetration and fixation of magnesium ions inside the cell.

Foods rich in vitamin include: meat and offal, brewer's yeast, nuts and beans, avocado. Alcohol and nicotine impair the absorption of pyridoxine from food. [ 2 ]

Symptoms leg cramps in pregnancy

Most often, the cramp problem during pregnancy appears in the legs, and especially in the calf muscles. Cramps are painful muscle twitching, and in some cases, you can even see strong tension in individual muscles under the skin. Muscle spasm zones are detected as painful seals, and it is completely impossible to resist such muscle contraction on your own.

Cramps occur mainly in the evening or at night, when the woman assumes a horizontal position. The spasm occurs at the level of muscle cells, which are intensely excited and therefore contract.

During the entire period of pregnancy, the female body experiences a colossal load. The volume of circulating blood increases, the blood flow from the veins worsens, the water-electrolyte ratio changes, the consumption of vitamins and microelements increases - for example, calcium, magnesium, vitamin D and other components involved in metabolic processes and helping to assimilate each other.

The first signs of problems may appear already in the first weeks of pregnancy, especially if there was a violation of the water-salt balance, nutritional deficiencies, venous diseases, etc. A typical onset is the appearance of night cramps in individual muscle groups (most often in the calf muscles). In the morning, there may be a slight dull pain in the calves caused by convulsive muscle strain, as well as general weakness, drowsiness, and a feeling of fatigue.

Leg cramps at night during pregnancy can manifest themselves in different ways. For example, in some women it looks like a relatively long period of muscle tension, like "a leg cramp". Other women point to a short series of weak contractions, during which the muscles seem to "tremble".

The localization of leg cramps can vary: from the toes to the foot, ankle, calf muscles, popliteal area, etc. Depending on the duration and type of muscle spasms, cramps are divided into the following symptomatic varieties:

• Myoclonic contractions are rhythmic and arrhythmic twitching and jerking that are not accompanied by pain.
• Clonic contractions are rhythmic spasms that can result in a “long-lasting” attack, similar to muscle tremors.
• Tonic contractions are the well-known condition of “leg cramp”, when a muscle spasms and does not release for some time. Such leg cramps in the morning during pregnancy occur most often, and are accompanied by painful sensations and extreme discomfort.
• Mixed type tonic-clonic seizures in the calves of the legs during pregnancy are practically not encountered, since they are related to epileptic and epileptic-like pathologies.

Severe leg cramps during pregnancy can be caused by various factors, from problems with the nervous system and blood vessels to a banal vitamin and mineral deficiency. Depending on the clinical manifestations, the doctor prescribes the appropriate diagnostics and only then begins to correct the pathological condition.

Complications and consequences

Leg cramps during pregnancy are not always a harmless symptom. Even a deficiency of any vitamin or microelement in the body of a pregnant woman can result in dysfunction of individual organs, including vital ones.

It is not always possible for a woman to eat well and nutritiously during pregnancy, to eat greens, fruits and vegetables. The reason for this is hormonal changes, stress, toxicosis, digestive disorders. In addition, the load on the vascular network increases significantly - for example, everyone knows that the first signs of varicose veins often appear during pregnancy.

In order to prevent the development of adverse effects and pathological complications, you cannot treat cramps on your own. Any medications and procedures during pregnancy should be prescribed only by a doctor, after conducting the necessary diagnostics. For example, if a woman's body additionally needs vitamins, the doctor will help select a vitamin and mineral complex that will help get rid of leg cramps, and at the same time will not harm the intrauterine growth and development of the baby.

Diagnostics leg cramps in pregnancy

Finding the cause of leg cramps during pregnancy is usually not difficult, but it will require a number of diagnostic procedures. In particular, it is necessary to evaluate blood parameters, such as hemoglobin level, color index, serum iron levels and basic microelements. If the doctor suspects varicose veins of the lower extremities, he may prescribe Doppler ultrasound followed by a consultation with a vascular surgeon or phlebologist.

Tests your doctor may recommend include:

• general clinical blood test (will help to identify inflammatory processes, anemia, and get a general idea of the body’s health);
• determination of blood glucose levels;
• general urine test, Nechiporenko analysis (to assess the performance of the kidneys, which are directly involved in regulating water-electrolyte balance);
• blood biochemistry (a test that allows you to assess the functioning of the liver and kidneys).

Instrumental diagnostics may include Dopplerography or ultrasound examination of venous vessels. This is necessary to assess the quality of blood circulation and diagnose possible venous insufficiency.

Probably, in each individual case other diagnostic tests may be needed. This issue is decided by the gynecologist: if necessary, the patient will be referred to a specialist who will prescribe other diagnostic procedures.

Differential diagnosis

Differential diagnosis should be carried out with the following diseases and conditions:

• water-electrolyte imbalance;
• avitaminosis, mineral metabolism disorders, anemia;
• digestive disorders;
• toxicosis, vascular spasms;
• ARVI;
• a prolonged state of physical inactivity, or, conversely, sudden excessive muscle strain;
• varicose veins of the lower extremities.

Treatment leg cramps in pregnancy

The first thing a pregnant woman should do when she experiences leg cramps is to see a doctor. It is advisable to first consult with your gynecologist, or make an appointment with a therapist, phlebologist, or nutritionist - depending on the suspected cause of the disease.

Self-medication is strictly prohibited, because during pregnancy there is a high risk of harming the growing child. It is better to consult a doctor, undergo the necessary diagnostics, consult with specialists (neurologist, endocrinologist, etc.).

As a rule, after examination, the doctor prescribes drug treatment, taking vitamin complexes to replenish the deficiency of substances. Sometimes the problem can be eliminated without the use of drugs, simply by adjusting the diet, establishing a rest regime. Additionally, you can take a course of massage or reflexology sessions, at the discretion of the doctor.

What to do?

What can you do on your own to relieve leg cramps during pregnancy?

• Remove the possible cause of the cramp (eg, remove shoes).

• Raise your legs (above head level) and try to pull the entire plane of your foot towards you.
• Breathe deeply and fully, don’t be nervous.
• Do a light massage of your calves (you can do this with your hands or with a small massager).
• Apply a warm heating pad to your feet or take a warm shower.
• Relax, drink a cup of warm tea or water.

If the cramps do not go away, or even turn into pain, then you need to consult a doctor.

Medicines that a doctor may prescribe

Treatment for leg cramps during pregnancy can vary significantly depending on the cause of the painful condition. For example, for varicose veins, a doctor may recommend the use of such medications:

• Venotonics, or phlebotropes, or phleboprotective agents are a series of drugs that can increase the tone of veins, reduce specific venous manifestations and syndromes. Treatment with venotonics is effective if varicose veins are just beginning to develop. Typical representatives of venotonics are Detralex, Troxevasin, Venoruton.
• Venotonic external preparations are ointment, cream or gel products, such as Heparin ointment, Venoruton gel, etc.

Most often, leg cramps during pregnancy are a complex problem, so mineral and multivitamin preparations are almost always prescribed. Particularly popular are preparations such as Magne B ₆ (Magnikum), Calcium D ₃ Nycomed, as well as combined vitamin-mineral complexes. We will talk about vitamins separately below.

Detralex	A preparation of diosmin, hesperidin. It has venotonic and angioprotective properties, reduces the extensibility of veins, eliminates venostasis, increases capillary resistance, improves lymphatic drainage. Detralex for cramps during pregnancy is taken under the supervision of a doctor, 2 tablets per day (morning and night, with food). Possible side effects - dyspepsia.
Troxevasin capsules	Troxerutin preparation, capillary stabilizing and venotonic agent with anti-inflammatory and antioxidant activity. Take 2 capsules per day, with food. Duration of therapy is about a month.
Venoruton capsules	The drug strengthens capillaries and stabilizes their permeability, eliminates edema, leg cramps, trophic disorders. Usually taken in the amount of one capsule three times a day, for two weeks. Possible side effects - dyspepsia, headache.
Heparin ointment	The preparation is external, is a direct-acting anticoagulant, has anti-inflammatory and local analgesic properties. During pregnancy, the ointment is used with extreme caution, in very small quantities under the supervision of a doctor. Side effects: skin redness, local irritation, allergy.
Magnikum	A preparation with magnesium lactate and pyridoxine hydrochloride. For cramps, take one tablet twice a day with water. Side effects are rare and include allergies or digestive disorders.
Calcium D 3 Nycomed	A combination drug prescribed for the prevention and treatment of calcium and vitamin D deficiency. For cramps during pregnancy, one tablet of the drug is usually prescribed twice a day. Rare side effects may include minor digestive disorders.

Vitamins for cramps during pregnancy

Vitamins during pregnancy play the role of the most important regulator of intracellular biochemical processes. At the same time, a woman receives most of the vitamins from food, therefore, both before pregnancy and during the period of gestation, it is necessary to diversify the diet as much as possible, to introduce, if possible, a sufficient amount of plant foods: vegetables, fruit juices, berries, greens, etc.

In some cases, it is necessary to replenish the vitamin deficiency using special vitamin and mineral complexes. Most often, they not only help get rid of leg cramps during pregnancy, but also improve the condition of the body as a whole, and even prevent the development of toxicosis. Synthetic vitamin preparations are not much different from those vitamin substances that are present in food products. Sometimes they are even better perceived by the body and are easier to digest.

What vitamins are especially needed for a pregnant woman to eliminate leg cramps? Of course, it is better to take a special test and check what specific substance the body lacks. But in most cases, no one wants to waste time identifying the problem, so you have to immediately take a vitamin complex recommended for expectant mothers. Such a complex must necessarily include folic acid, vitamin D, magnesium, iron, calcium and potassium.

Why are multivitamin preparations considered the best option for pregnancy cramps? The fact is that in the overwhelming majority of metabolic mechanisms, vitamins and minerals participate, interacting with each other. For example, magnesium should always be taken together with B vitamins, and calcium with vitamin D.

It is recommended to take combination drugs before conception and during the entire pregnancy period: this often allows you to prevent leg cramps in advance. If cramps have already appeared, then in most women they disappear within a few days of taking the combination drug. What drugs are we talking about?

• Doppelherz Active – vitamins for mom;
• Now Foods Prenatal Vitamins;
• Prenatabs Solgar;
• Alphabet Mom;
• Vitrum prenatal (or Vitrum prenatal forte);
• Elevit pronatal.

These drugs are most often used by women during pregnancy, but only a doctor can recommend their use (there are contraindications).

Physiotherapy treatment

Physiotherapy for leg cramps during pregnancy is used relatively rarely. Regular contrast dousing of the lower extremities, alternate application of ice and external heat, and light massage help well and alleviate the condition. Special exercise therapy exercises are practiced, and in case of severe cramps - bed rest. In addition, wearing medical underwear, bandages, etc. is recommended.

In fact, among physiotherapeutic methods, such procedures as ultraviolet irradiation, transcutaneous electrical neurostimulation, and acupuncture are particularly popular. There are cases of successful use of low-frequency non-thermal magnetic therapy: this method perfectly removes tissue swelling and pain, restores a healthy balance of sodium and potassium ions, and alleviates muscle-tonic manifestations.

Ultraviolet exposure in the wave range of 320-280 nm is considered one of the most preferred procedures, since it does not lead to hypervitaminosis D ₃ (the risk of its development is present with internal use of the corresponding drugs). In case of painful cramps, UFO is carried out in erythemal dosages: starting with 2-3 biodoses with a further increase to 5-8 biodoses.

Electrophoresis sessions with calcium and phosphorus in combination with general ultraviolet irradiation are recommended.

Folk remedies

There are folk recipes for relieving leg cramps, but during pregnancy the possibility of using them should be discussed with a doctor. In general, such methods are approved by official medicine and help to significantly improve the condition of women during such an important period for them.

• If the cramps are caused by a lack of calcium in the pregnant woman's body, it can be replenished with eggshells. The shells should be fresh and well washed: they are calcined for 10 minutes in the oven or microwave, then ground in a mortar to a powder state. This powder is taken daily, in the morning, in the amount of 1-2 g. Immediately before use, you need to add a few drops of lemon juice to it. You can eat the dose separately from other products, or add it to cottage cheese, yogurt, salad.
• A great remedy for leg cramps is lemon juice. In the morning and at night, rub it on your calves and feet, both for prevention and for treatment. After applying the juice, do not wipe it off or wash it off: it must be absorbed into the skin itself.
• Take 20 g of dry crushed bay leaf, pour in 250 ml of unrefined vegetable oil, leave to infuse for 12 days. Sometimes the potion needs to be shaken and stirred. When the medicine is ready, it needs to be filtered and used to rub the legs for cramps.

Herbal treatment

• Licorice rhizome improves nutrition of the lower limb muscles. This plant is able to normalize the tone and nerve conductivity of muscle tissue. To prepare the potion, take 100 g of dry rhizome and infuse in 500 ml of boiling water until cool. Take 1 teaspoon three times a day.
• A decoction of hawthorn berries has an excellent anticonvulsant effect: 3 tablespoons of berries are poured with 500 ml of boiling water, kept on low heat for five minutes, then infused under a lid for about three hours. Take 2 tablespoons of decoction 5 times a day for 20 days.
• For leg cramps during pregnancy, take one portion of fresh celandine juice and mix it with two portions of liquid Vaseline. Rub the resulting mixture onto your legs where cramps appear. If you repeat the rubbing daily, the cramps will stop bothering you within two weeks.

Homeopathy for pregnancy cramps

Homeopathic remedies are safe and can be used during pregnancy under the supervision of a doctor. Most often, leg cramps are eliminated by the following homeopathic remedies:

• Zincum 6 alternates with Belladonna 3, initially every half hour, then less often, bringing it up to 2 times a day;
• Sulfur 3, Veratrum 3, Secale cornutum 3, Stronziana carbonica;
• Causticum 6, 5 drops twice a day;
• Ignacia 6, Stramonium 6, Platinum 6.

The dosage and selection of drugs is carried out by a homeopathic doctor during an individual appointment.

Surgical treatment

People turn to a surgeon for help mainly in cases where leg cramps during pregnancy are associated with varicose veins. A worsening condition requiring surgical intervention may be accompanied by:

• severe swelling of the legs;
• formation of ulcers;
• multiple hematomas on the legs;
• dryness and constant itching of the skin;
• thrombus formation in the vascular lumen.

If possible, radical methods of eliminating seizures are postponed until after the birth of the child. During pregnancy, operations are performed only in extreme cases.

To eliminate cramps in varicose veins, the following surgical treatment methods can be used:

• Sclerotherapy – is prescribed to eliminate visible vascular network or medium-sized venous vessels. Using a microneedle, a sclerosing solution is introduced into the vascular lumen, causing gradual resorption of the vein. A full course of treatment usually requires several procedures, after which the progression of the pathology usually stops.
• Miniphlebectomy is the surgical removal of varicose veins through skin punctures. Anesthesia is usually local, the procedure is relatively simple. It can be used as an adjunct to other basic therapeutic methods:
  • endovascular laser coagulation;
  • CHIVA;
  • ASVAL.
• Phlebectomy is a full-fledged surgical intervention, usually used for advanced varicose veins, or in the presence of contraindications to other laser treatment methods.

Prevention

If you follow certain preventive rules, you can try to avoid unpleasant leg cramps during pregnancy:

• Eat properly and fully, often and little by little, without overeating. Instead of sugar, eat complex carbohydrates (cereals, pasta made from durum wheat varieties), fruits. Focus on products rich in calcium, potassium and magnesium: we are talking about bananas, greens, fermented milk products, nuts and seeds, dried fruits, citrus fruits.
• Drink plenty of fluids daily. If you experience swelling in your legs, consult your doctor – you may need to limit the amount of salt you consume.
• Load your body wisely: both excessive physical activity and its complete absence are equally dangerous.
• Choose your shoes and clothes correctly: they should be comfortable, not tight, light, made of natural materials. You should not wear high-heeled shoes, thick synthetic pants (for example, "leggings"), socks and knee-highs with a thick elastic band.
• Periodically try to rest by raising the "foot" end of the bed. If there are obvious signs of fatigue in the legs, you can do a contrast bath or a light massage.
• In cold weather or if you are prone to constant “chillyness”, you should wear warm socks – for example, while sleeping.

If you follow these tips, leg cramps during pregnancy will not bother you.

Forecast

As a rule, after childbirth, cramps pass and do not return. If there is any pathological cause for this discomfort, it is advisable to take measures and undergo treatment. To do this, you must consult a doctor and, possibly, undergo diagnostics.

You should never "prescribe" medications to yourself. Without knowing the true cause of the problem, such self-medication can only harm and even worsen the problem.

With a question about leg cramps during pregnancy, you should first of all contact the gynecologist who is observing the woman at the antenatal clinic. If he deems it necessary, he will prescribe a consultation with a more specialized specialist - for example, a neurologist, surgeon, endocrinologist, phlebologist. Treatment and prognosis in this case are determined strictly individually, based on the results of clinical and laboratory studies.