Remedies for itching 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)

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Last reviewed: November 2020

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Causes, Treatments, When to See Your OB

Scratch, scratch, scratch. All of a sudden it feels like all you can think about it how much you itch. Your pregnancy may have brought on a whole host of new “fun” experiences: dizziness, nausea, heartburn, or even trouble breathing.

You’d likely been warned about all of these from other pregnant women and weren’t shocked when you hit these milestones in your pregnancy journey. The last thing you imagined you’d be feeling though was itchy!

You hadn’t heard about intense itching during pregnancy from a lot of your friends, so now you’re wondering: What’s causing this? Is this normal? Should I be worried?

Although we can’t diagnose the exact cause of your itchiness, we’ve compiled a list of some common reasons pregnant women may be feeling the urge to scratch — and some signs you should head in to see your doctor.

There are many reasons why you may feel itchy during pregnancy. These might include:

Stretching skin. First pregnancies and pregnancies with multiples tend to cause skin to stretch quite a bit more than it is used to.
Dryness. Hormone changes in pregnancy can cause itchy, flaky dry skin.
Perfumes or fabrics. Different materials and chemicals can literally rub you the wrong way.
Hormones. The hormonal changes you experience in pregnancy can affect everything from mood to circulation to, yes, itchiness.
Cholestasis. This is a liver disorder that can result in the buildup of bile acids in the blood that cause feelings of itchiness.
Pruritic urticarial papules and plaques of pregnancy (PUPPP). This is an itchy rash that occurs around stretch marks during late pregnancy.
Prurigo. These crusty, itchy bumps on the arms, legs, or abdomen that can appear in any trimester.

It’s important to consider where on your body you are experiencing itching. Most pregnancies will involve some itching belly and itching breasts because the skin in these areas is going through so many changes.

Itching around your stretch marks may be a result of PUPPP, while itchy arm and leg areas are more likely to be a result of fabrics rubbing you the wrong way or prurigo.

Occasionally feeling slight itchiness is normal, but intense itching of the abdomen, arms, and legs can be a sign that your body needs some attention. Some people also experience vaginal itching during pregnancy, which may require treatment. In addition, sometimes there may be rashes associated with pregnancy itching.

Itching is not generally considered an early pregnancy symptom. In fact, many types of rashes typically only appear later in pregnancy and some may not resolve until after your baby is born.

That said, any time intense or prolonged itching appears during the course of your pregnancy it should be reported to your doctor.

Just as there are many potential causes for itchiness in pregnancy, there are a variety of ways to help alleviate any itching that you may be feeling. Consider these natural remedies you can try at home:

Change perfumes or detergents. You may even consider making your own soap/perfumes/detergents to avoid chemicals in commercial products that irritate your skin.
Wear loose clothing made from natural fabrics. (This will help keep potentially irritating fabrics away from your skin AND help keep you cool to avoid any heat-related rashes!)
Take an oatmeal bath or use a yogurt skin treatment. Lathering up with pine tar soap is a common home remedy for PUPPP.
Use a moisturizer to help with dry skin. Olive oil and coconut oil are both very moisturizing as are shea and coconut butter.
Apply some calamine lotion. This chalky pink liquid isn’t just for bug bites and poison ivy!
Increase your water intake and make sure that you’re staying hydrated. Don’t forget to include electrolytes in your hydration. Making sure to include some coconut water or a water with electrolytes added will help your body to make the most of the water that you’re providing it.
Turn on your humidifier and/or a fan. Keeping the air moist and cool will help with dry skin and itchy heat-related rashes.

Remember: If itching doesn’t improve or gets worse, it’s time to make plans to visit your doctor!

You should see your doctor if you have any of the following.

Signs of cholestasis

jaundice (a yellowing of the skin and the white area of the eye)
dark urine
lack of appetite
nausea
light stool
depression
intense itchiness, including itching feet

Cholestasis is a liver condition that results in a build-up of bile acids in the blood. There is not usually a rash, but the skin may develop a more yellow tone. In pregnancy, the condition, if it does appear, occurs in the third trimester.

Your doctor will diagnosis cholestasis with a blood test. A medical history will also typically be taken, because cholestasis can be an inherited condition and is more common if your mother or sister also had it during one of their pregnancies.

Many over-the-counter anti-itch medications will not be effective if cholestasis is the cause of your itch, but your doctor may be able to prescribe other drugs that can help alleviate some of the itchiness and reduce the amount of bile acid in the blood.

Ultimately, the solution to cholestasis is delivering the baby, and the itch will usually clear up within a few days of giving birth.

Because there is an increased chance of stillbirth, fetal distress, and preterm delivery, your doctor may want to discuss an earlier induction or more frequent monitoring during your pregnancy (and for a period after delivery) if you are diagnosed with cholestasis.

Signs of PUPPP

rash made up of small, pimple-like dots, typically spreading from stretch mark areas and not extending beyond the breasts
blisters around the rash
feeling extra itchy at night

Typically, your doctor will diagnose PUPPP through a skin examination. In rare cases a skin biopsy may be ordered. Blood work to rule out an infection may be done as well.

The ultimate cure for PUPPP is to deliver the baby, and the rash will usually be gone within a few weeks of delivery. Moisturizers, steroid creams, and antihistamines prescribed by your doctor, as well as itch relieving baths, can help to temporarily relieve itchiness until your due date.

Signs of prurigo

itchy, crusty bumps on the arms, legs, or abdomen

While moisturizers may help with the itch from prurigo, treatment typically involves topical steroids and oral antihistamines. If you’ve had prurigo during one pregnancy, there’s an increased chance that you’ll experience it in future pregnancies. While it may clear up shortly after giving birth, it can also unfortunately last for weeks or even months after giving birth.

If you feel intensely itchy or itchy for a prolonged time during your pregnancy, it’s a good idea to check in with your OB or midwife. They can prescribe medications, rule out various illnesses, and make sure that you and your little one are safe.

That intense itch you’re feeling during pregnancy could be due to many different things. It’s important to think about any other symptoms you’re experiencing, the timeline of your itchiness, and even just your daily activities to figure out how to solve this uncomfortable problem.

Because itchiness can be a symptom of a more serious condition, it’s important to consult with your doctor if it continues or any other symptoms appear.

After all, you don’t want your itching to distract you from experiencing the morning sickness, heartburn, and frequent trips to the bathroom you’ve been warned about from other pregnant women!

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, excluding 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.

You can get answers to any questions about pregnancy and childbirth from leading EMC experts in the classes of the School of Moms.

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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.