Premenstrual Edema and Edema of Pregnancy

Many women retain fluid during pregnancy and during the last days of the menstrual cycle. Breast fullness and subcutaneous swelling or puffiness are the most commonly observed symptoms; they are largely the result of elevated circulating hormone levels in the blood. Estrogens possess some mineralocorticoid activity, and thus, when present in relatively high concentrations, may produce some expansion of the extracellular fluid compartment. Excessive premenstrual edema frequently responds well to thiazide therapy. Recent experience has diminished enthusiasm for use of any diuretics in pregnant women. Since the edema of pregnancy is frequently well tolerated, concerns of compromised uteroplacental perfusion, possible ineffectiveness of diuretics in preeclampsia, and the risk of adverse effects of diuretics on the baby (e.g., thiazides can both cross the placental barrier and appear in breast milk, producing electrolyte disturbances and thrombocytopenia in newborns) have led to diminished routine use of these agents in pregnancy.

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