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BACKGROUND: Varicose veins are a common vascular complication during pregnancy, caused by hormonal, mechanical, and hemodynamic changes. They can lead to discomfort, edema, and in some cases complications, yet are often under-recognized and undertreated. This study aimed to evaluate the prevalence, timing, and risk factors associated with lower limb varicose veins during pregnancy, and to identify independent predictors of clinically significant varicose vein symptoms.METHODS: This observational study included 42 pregnant women admitted for delivery at the Clinic of Gynecology and Obstetrics, University Clinical Center of Kosovo, Prishtina. Women aged ≥18 years with singleton pregnancy and clinically significant lower limb varicose veins (CEAP C2 or higher) were enrolled. Exclusion criteria were previous venous thrombosis, prior venous surgery, or secondary venous disease. Data were collected through structured patient interviews and medical record review. All participants underwent clinical examination, with varicose veins identified in the lower limbs and, when present, the vulvar region, and classified according to the CEAP system. Echo-color Doppler ultrasound was performed in a subset of patients (21/42) to assess venous reflux and anatomical involvement. Recorded variables included maternal age, parity, gestational trimester at symptom onset, family history of varicose veins, occupational prolonged standing (≥6 h/day), symptoms, anatomical distribution, and management strategies. Conservative treatment measures, including limb elevation and compression therapy, were applied, and postpartum outcomes were documented. Univariate statistical analyses were performed using appropriate parametric or non-parametric tests, with statistical significance set at P<0.05.RESULTS: Among 145 pregnant women examined, 42 (29.0%) were found to have clinically significant varicose veins. The most frequently reported symptoms were numbness (52.4%), pain, cramps, and aesthetic concerns (each 45.2%), followed by leg heaviness and skin discoloration (each 42.9%). Burning sensation, throbbing pain, pricking sensation in the sole, and fear were less commonly reported. Comorbidities were present in seven patients (16.7%), with no single condition exceeding 2.4%. Most participants reported no adverse lifestyle habits (73.8%); smoking was reported by 14.3%, while alcohol consumption and regular physical activity were uncommon. More than half of the cohort were housewives (52.4%), and 54.8% reported a positive family history of varicose veins.CONCLUSIONS: Our findings suggest that high-parity women and those with a family history may benefit from early monitoring and preventive strategies for varicose veins during pregnancy. Further research with larger cohorts is needed to validate these findings and to explore the impact of preventive interventions, such as compression therapy or early lifestyle modifications.