Changes in the diameter and valve closure time of leg veins in primigravida women during pregnancy Akram M. Asbeutah, PhD, DMU, AMS, MSVU, a Majedah Al-Azemi, FRCOG, b Samah Al-Sarhan, MD, c Abdullah Almajran, MSc, d and Sami K. Asfar, MD (UK), FRCSEd, FRCS, FACS, e Kuwait City, Kuwait Objective: The aim of this study was to monitor the changes that develop in leg veins of primigravida women during pregnancy. Methods: Sixty primigravida women volunteered to undergo clinical evaluation and duplex ultrasound examination of both lower limb veins to monitor changes in vein diameter and valve closure time (VCT) during pregnancy and 3 months postpartum by duplex ultrasound. A total of four readings were taken for each subject, one reading for each trimester and the last reading at 3 months postpartum. Results: The mean (%standard deviation) age of participants was 26.82 % 2.47 years; 39 limbs (32.5%) and 65 limbs (54.2%) developed C1-C3 venous changes during the second and third trimesters, respectively. Three months post partum, 36 limbs (30%) continued to have C1-C2 changes. Only four limbs in four subjects developed varicose veins along the great saphenous vein, and their VCT was more than 1 second. These subjects were found to have a family history of varicose veins. Duplex examinations showed that there was a gradual increase in the diameter and VCT from the second trimester through the third trimester of pregnancy in all examined venous seg- ments. These changes were statistically significant by Fried- man and related-samples Wilcoxon signed rank tests within the same legs (P [ .001) but not between legs in the same subject (P > .05), even with adjustment for body mass index (P [ .001-.049). Conclusions: In primigravida women, lower limb veins showed gradual increase in vein diameter and in VCT starting from the second trimester. These changes reverted to baseline in most cases 3 months after delivery. (J Vasc Surg: Venous and Lym Dis 2015;3:147-53.) The reported annual incidence of new cases of varicose veins is 2.6% in women and 1.9% in men, with associated costs to the community in terms of lost working hours, hos- pitalization, and management. 1-5 Two theories describing the pathogenesis of varicose veins have been proposed, the valvular theory and primary weakness of the vein wall. 6,7 Both theories have the same end result, that is, the venous valves fail to maintain efficient upward blood flow, resulting in retrograde blood flow and an increase in the venous pres- sure within the leg veins, which, with time, leads to dilated tortuous veins. If this is not treated, chronic venous hyper- tension will ensue with its consequences of hyperpigmenta- tion, ulceration, and lipodermatosclerosis. 8,9 Known risk factors for the development of varicose veins are family history, age, race, weight, occupation, oral contraceptive use, cardiovascular disease, and preg- nancy. 10-13 The prevalence of varicose veins in women has been reported to be around 25% to 33% compared with 10% to 20% in men. 1-3 Parous women were shown to have an increased risk for development of varicose veins compared with nulliparous women. 10 We have recently studied the changes in the leg veins during the menstrual cycle of single university students. In this study, we showed a significant increase in the vein diameter and valve closure time (VCT) of five venous seg- ments including the common femoral vein, femoral vein, popliteal vein, and great and small saphenous veins during the menstrual cycle. 14 To further elucidate the relationship of the female gender to the development of varicose veins, we thought that it would be prudent to perform such a study in primigravida women who never had a history of varicose veins. If significant changes are demonstrated, it would perhaps indicate that conservative measures should be taken during pregnancy, like wearing of a class 1 compression garment throughout pregnancy, to prevent the future development of varicose veins with subsequent pregnancies. METHODS Subjects. In the period from September 2012 to May 2014, 67 young primigravida women agreed to participate in this study; of these, seven were excluded (three had an abortion and four left the country). Their mean age (6standard deviation) was 26.82 6 2.47 years. They From the Department of Radiologic Sciences, Faculty of Allied Health Sciences, Kuwait University a ; the Department of Obstetrics and Gynecol- ogy, Faculty of Medicine, Kuwait University b ; Department of Obstetrics & Gynecology, Maternity Hospital, Al-Ihgaqi Center, Ministry of Health c ; the Department of Community Medicine and Behavioural Sci- ences, Health Sciences Centre, Faculty of Medicine, Kuwait University d ; and the Department of Surgery, Faculty of Medicine, Kuwait University and Vascular Surgery Unit, Mubarak Al-Kabeer Hospital, Ministry of Health. e Author conflict of interest: none. Reprint requests: Akram M. Asbeutah, PhD, Assistant Professor, Department of Radiologic Sciences, Faculty of Allied Health Sciences, Kuwait University, PO Box 31470, Kuwait City, Kuwait 90805 (e-mail: asbeutah_akram@hotmail.com or akram.asbeutah@hsc.edu.kw). The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. 2213-333X Copyright Ó 2015 by the Society for Vascular Surgery. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jvsv.2014.09.005 147