Itching cream during pregnancy

Itching during pregnancy | Pregnancy Birth and Baby

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Mild itching is common in pregnancy because of the increased blood supply to the skin. As your pregnancy progresses and as your baby grows, the skin of your abdomen is stretched and this may also feel itchy.

Mild itching is usually nothing to worry about, but if the itching becomes severe it can be a sign of a serious liver condition called obstetric cholestasis. This affects fewer than 1 in 100 pregnant women, but needs medical attention.

Mild itching

Wearing loose clothes may help prevent itching, as your clothes are less likely to rub against your skin and cause irritation. You may also want to avoid synthetic materials and choose natural fabrics such as cotton that allow the air to circulate close to your skin. You may find that having a cool bath or applying lotion or moisturiser can help to soothe the itching.

Some women find that products with strong perfumes can irritate their skin, so you could try using plain lotion or soap.

Serious itching: obstetric cholestasis

If you’re worried about your itching, or if you have severe itching, it’s important to see your midwife or doctor.

Obstetric cholestasis (OC), also called intrahepatic cholestasis of pregnancy, is a serious liver disorder that affects a small number of pregnant women, usually in the last 3 months of pregnancy.

Causes of obstetric cholestasis

The cause of OC is unclear, but it’s thought the rise of pregnancy hormones later in pregnancy may slow the normal flow of bile — the digestive fluid made in the liver that helps your digestive system break down fats. In OC, bile salts build up rather than leaving the liver, eventually entering the bloodstream, which can make you feel itchy.

OC seems to run in families, although it can occur with no family history. It is also more common in women of Indian and Pakistani origin. If you have had OC in a previous pregnancy, you're more likely to develop it again in a subsequent pregnancy.

Babies of women with OC are more likely to be born prematurely or to be stillborn, or to have lung problems from breathing in meconium. Because of these complications, your doctor may consider inducing labour before you are due.

Symptoms of obstetric cholestasis

The classic symptom of OC is itching without rash, usually on the palms and soles of the feet, but it may be more widespread. The itching can be non-stop or unbearable, and worse at night.

Other symptoms include dark urine, jaundice (yellowing of the skin and whites of the eyes), and pale bowel movements (poo).

The itchiness usually goes away within a few days after giving birth.

Treatment of obstetric cholestasis

OC is diagnosed through taking a medical and family history, and blood tests that check your liver function (liver functions tests — LFTs). Once OC is diagnosed, you will have regular LFTs until your baby is born, so that your doctor can monitor your condition.

Creams, such as calamine lotion, are safe to use in pregnancy and can provide some relief from itching. Your doctor may prescribe a medication to reduce bile salts and ease itching.

OC can affect your absorption of vitamin K, which is important for healthy blood clotting so you may be offered a vitamin K supplement.

If you are diagnosed with OC, your midwife and doctor will discuss your health and your options with you.

Sources:

Mayo Clinic (Cholestasis of pregnancy), NSW Health (Having a baby), Royal Women’s Hospital (Common concerns in early pregnancy), SA Health Department (Clinical guideline obstetric cholestasis), Women's and Children's Health Network (Itching in pregnancy), King Edward Memorial Hospital (Cholestasis in pregnancy - clinical guidelines)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: November 2020

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How to Treat Itchy Skin Naturally During Pregnancy

During pregnancy, as the blood supply to the skin increases, it is very common to experience mild itching. You may also experience itching as the skin on your abdomen stretches. If you experience mild itching during pregnancy, there are several natural steps you can take to alleviate your symptoms.

Regularly apply an unscented lotion or moisturizer.
Wear clothing that is loose so it is less likely to irritate the skin.
Try to wear clothing made of natural fibers, such as cotton, which are more breathable than synthetic materials.

How to Treat Itchy Skin During Pregnancy When Naturally Doesn’t Work

If natural options do not work, you may consider taking medication. You may also find calamine lotion beneficial in alleviating the itching. Keep in mind, however, that the safety of using calamine lotion during pregnancy and breastfeeding is unknown, so make sure to talk with your doctor before using it.

When Itching is Severe Contact Your Healthcare Provider

More severe itching may indicate an underlying liver condition known as Intrahepatic Cholestasis of Pregnancy (ICP) or Obstetric Cholestasis (OC). Your doctor may perform a set of liver function tests (LFTs) to determine if you have obstetric cholestasis. If you are diagnosed with OC, your doctor will need to regularly perform LFTS for the duration of your pregnancy to monitor the health of both you and the baby.
While there is currently no cure for OC, some options for easing symptoms include taking a warm bath or applying ice to an itchy area of skin. As OC can interfere with the absorption of vitamin K, which is necessary for proper blood clotting, your doctor may also recommend that you take a vitamin K supplement.
OC is a liver condition that disrupts the flow of bile in the body during pregnancy. Bile salts generally flow from the liver to the digestive tract to aid in digestion. With OC, the flow of bile is disrupted causing a buildup of bile in the body. This can cause severe itching all over the body, although for some women, itching occurs primarily on the hands and feet.
Such itching may worsen at night but is not typically accompanied by a rash. Other symptoms may include dark urine, gray bowel movements, and Jaundice (yellowing of the skin and whites of the eyes).
OC occurs most commonly during the third trimester, although it can develop earlier. The good news is that it generally subsides within a few days after delivery.
While OC affects less than 1% of pregnant women, it is a potentially serious condition that needs to be monitored by your doctor, particularly as it increases the risk for pregnancy complications such as preterm birth and stillbirth.

An additional condition that may cause itchiness is prurigo of pregnancy

This condition is characterized by small, itchy bumps on the skin which may be mistaken for insect bites. Prurigo can occur at any point during pregnancy and may continue post-delivery. Many believe it is caused by changes in immune function during pregnancy. Fortunately, prurigo poses no risk to your baby.
To treat prurigo, your doctor may prescribe topical emollients or steroids combined with oral antihistamines.
For OC, it is not recommended to use antihistamines or corticosteroid creams during pregnancy as they may be harmful to your baby. However, medications, such as Urso, can help reduce bile in the mother’s blood.
These medications also alleviate itchiness and reduce the risk of complications for the fetus. Urso is safe to take during pregnancy, although caution is advised when using it while breastfeeding.
While such medication may help treat OC, your doctor may also want to induce labor early to prevent complications such as stillbirth. If you have OC, make sure to talk with your doctor or midwife about your options.

Want to Know More?

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Compiled using information from the following sources:

1. ICP Care. (n.d.). What is ICP? Overview.

2. Mayo Clinic Staff. (2014, August 16). Cholestasis of pregnancy.

https://www.mayoclinic.org/diseases-conditions/cholestasis-of-pregnancy/basics/definition/con-20032985

3. National Health Service. (2014). Itching and obstetric cholestasis in pregnancy.

https://www.nhs.uk/conditions/pregnancy-and-baby/pages/itching-obstetric-cholestasis-pregnant.aspx#close

4. PDR Network. (n.d.). Drug summary: Urso 250/Urso Forte.

https://www.pdr.net/drug-summary/urso-250-urso-forte?druglabelid=2807

5. PDR Network. (n.d.). Drug summary: Calamine.

https://www.pdr.net/drug-summary/calamine?druglabelid=2638

6. Sachdeva, S. (2008). The dermatoses of pregnancy. Indian Journal of Dermatology, 53, 103-105. doi: 10.4103/0019-5154.43203

7. The American College of Obstetrics and Gynecologists. (2014). Skin conditions during pregnancy.

https://www.acog.org/Patients/FAQs/Skin-Conditions-During-Pregnancy

Why does the skin itch during pregnancy?

Skin itching during pregnancy is not a very common phenomenon. Most often, the skin begins to itch unbearably (as after mosquito bites) in the evening, closer to night, which can provoke insomnia and generally worsen a woman’s mood. Usually itching does not harm the baby and goes away after childbirth. However, it is still worth consulting with a gynecologist and dermatologist.

What does it come from?

The cause of itching during pregnancy in most cases is a violation of the liver: the production and outflow of bile, a general increase in the level of bilirubin in the blood. This is due to a hormonal failure in the body of the future mother - a violation of the synthesis of estrogens, as well as due to fetal pressure on the bile ducts. The fatty acids produced in large quantities enter the woman's skin with the bloodstream and irritate the nerve endings, causing excruciating itching. Similar phenomena associated with stagnation of bile in the body can make themselves felt in the third trimester of pregnancy. Sometimes itching is accompanied by such dangerous diseases as diabetes mellitus.

Who is predisposed?

Itching during pregnancy is usually observed in women with chronic diseases of the biliary tract and with high levels of cholesterol in the blood. Such future mothers need to regularly (at least once a month) do a biochemical blood test to exclude toxic effects on liver cells.

How to fight?

A pregnant woman should tell her gynecologist about the discomfort associated with skin itching. In some cases, itching can be a sign of the development of such a dangerous disease as hepatitis. The doctor will conduct appropriate examinations. If, according to an objective examination, itching does not pose any danger, it is often possible to get rid of discomfort simply by following a diet aimed at lowering cholesterol levels, limiting the intake of fatty, spicy and salty foods that prevent the liver from coping with the function of bile secretion, as well as drinking plenty of water - it is necessary to eliminate dry skin. If the diet does not help, the doctor may prescribe choleretic drugs suitable for pregnant women.

It is important to find the cause of the bothersome itching, eliminating a whole group of skin diseases that can occur during pregnancy.

Itching in the abdomen and chest

This itch is worth mentioning separately. As a rule, the skin on the abdomen or chest itches in the second and third trimesters due to its stretching, because it is these parts of the body that increase in volume during pregnancy. In this case, it is very important not to scratch the skin - this will lead to the appearance of stretch marks, which, unlike itching, will not go away after childbirth. Regularly use moisturizing creams, special products for stretch marks, do a light massage of the chest and abdomen with circular movements of your fingers and do not take hot showers.

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Interventions for the treatment of cholestasis during pregnancy

This translation is out of date. Please click here for the latest English version of this review.

Obstetric cholestasis is a liver disorder during pregnancy that most often occurs in the third trimester of pregnancy. The main symptom of this condition is itchy skin, which can be quite distressing for a pregnant woman. Bile acids accumulate in the liver and their blood levels also rise. Signs and symptoms of this condition resolve spontaneously within the first few days after delivery or within two to three weeks. This condition has been associated with preterm birth and is thought to be associated with complications such as miscarriage and stillbirth. Most doctors deliver earlier to reduce the risk of stillbirth. Treatments such as ursodeoxycholic acid (UDCA) and S-adenosylmethionine (SAM) detoxify bile acids or change their solubility. Several agents (activated charcoal, guar gum, cholestyramine) have been used to bind bile acids in the intestine and remove them. Some of these agents have potential adverse effects on mothers due to a reduction in vitamin K, which is essential for blood clotting.

We included 21 randomized controlled trials with a total of 1197 participants in this review. The risk of bias in most trials was moderate to high. Compared to placebo, UDCA resulted in a reduction in itching in five trials (228 women), no benefit was seen in one trial (16 women), and another trial reported improvement only in women with severe disease (94 women). Five clinical trials (304 women) reported unborn child distress or symptoms of asphyxia, and although there were fewer cases of fetal distress in the UDCA groups compared with placebo, the differences were not statistically significant. The results of four clinical trials comparing SAM and placebo were inconsistent. Two trials (48 women) reported a reduction in pruritus with SAM compared with placebo, and two trials (34 women) reported no significant difference between groups in the resolution of pruritus.