Why Does Pregnancy Make Some Women's Feet Swell, and Not Others'?

Jessica Simpson, who is expecting her third child with husband Eric Johnson, recently hit up social media asking followers for help dealing with her third trimester swollen feet. “Any remedies?! Help!" she wrote on a closeup photo of a dramatically swollen left foot. What she got was a whole community of women sharing their own experiences of edema, or swelling, during pregnancy.

With celebrities like Simpson living out their pregnancies in the public eye, everything from their maternity fashion to cravings is a topic of conversation. All this attention also brings awareness of prenatal symptoms that, common though they may be, might require medical attention for some women.

Having watched my swollen feet and ankles size out of shoe after shoe in the last three months of my own pregnancy, I could empathize with Simpson. In my experience, no matter what medical advice I followed, it took a full nine days postpartum for my edema to go away and for my wedding band to fit on my finger again. So I set out to find out what gives: Why do some women, like Beyoncé and Kim Kardashian, end up with swollen feet during pregnancy, while and others, like Meghan Markle and Blake Lively, seemingly don’t? What causes swelling in the first place, and most importantly, when should expectant moms seek medical attention?

While some women may not look like they’re swollen, like Kelly Clarkson’s totally relatable tweet suggests, in actuality all women get edema during pregnancy. Yes, even the Markles and Ciaras of the world.

“All women get some swelling in their ankles but a little bit depends on factors within and out of their control,” says Dr. Peter S. Bernstein, director of Maternal Fetal Medicine at Montefiore Health System. Edema, which just means swelling, is normal in pregnancy, as the fluid in the body increases to support circulation and pump blood to the growing uterus. The amount of protein in a woman’s blood and how much time she spends on her feet during the day are major contributing factors to edema, and that extra fluid follows the laws of gravity — it tends to go to areas that are lowest, like feet and ankles. According to the American Pregnancy Association, edema tends to increase as a woman’s uterus grows and is most noticeable in the third trimester.

Edema can take a bit of time to resolve, according to Bernstein, even after a woman gives birth. “Women who have cesareans get quite a bit of intravenous fluid and can get a bit more of edema than women who have vaginal deliveries,” he explains. For most women, the swelling should resolve itself within a week or two but it can take up to a month postpartum.

While it’s going on, there’s not a ton women can do to deal with edema. They should avoid standing for long periods when possible, and elevate their legs while sitting. Bernstein also recommends pregnant women wear compression socks to aid with circulation, as Claire Danes revealed she was during a hilarious appearance on Jimmy Kimmel Live last June. Bernstein also encourages women with edema to stand in a swimming pool, as the pressure from the surrounding water can aid in blood flow, and squeeze the fluid back into the blood vessels. The edema will return once you’re on dry land, but a swim will offer temporary relief. One thing you should never do? Dehydrate yourself. While the problem is related to excess fluids, you still need to drink plenty of water during pregnancy.

At times, edema can be a symptom of a much more serious condition like preeclampsia, which results in high blood pressure from excess protein in a woman’s urine. Women showing signs of preeclampsia will experience swelling beyond their ankles and feet, like their hands and face, over a number of days or a short period of time; they might also get headaches or blurred vision that should not be ignored. In that situation, Bernstein recommends getting your blood pressure checked. Thankfully, celebrities like Beyoncé and Kim Kardashian have discussed their preeclampsia diagnosis, bringing awareness to the symptoms women must pay attention to.

Beyonce, who revealed she was “swollen from toxemia,” another term for preeclampsia, was forced to release an official statement through her reps about her swelling following accusations that she got lip fillers during her pregnancy with twins Rumi and Sir. Kardashian, who had edema and preeclampsia during her first pregnancy with North, was a victim of horrific tabloid weight shaming and bullying, an experience she later said, “changed my mood; it changed who I was; it changed my personality a lot." The KUWTK star was also diagnosed with preeclampsia in her second pregnancy with Saint; she went on to use a surrogate for her third child and reportedly is in talks with another surrogate for a fourth.

As for Simpson, she had the last laugh on her pregnancy-swollen feet when she turned her edema into a meme, shutting down the 10-year challenge with a side-by-side photo of her swollen foot with that of her rocking her Daisy Dukes a decade ago. In the third trimester, as in life, laughter really is the best medicine.