Itching During Pregnancy
Frederick R. Jelovsek, MD
Itching during pregnancy is a common symptom. What many women don't realize, however, is that sometimes itching can be a sign of a liver abnormality called intrahepatic (within the liver) cholestasis (pooling of bile salts) of pregnancy. When associated with itching, the skin component is called pruritus gravidarum. It is a rare condition occurring in 1-2/10,000 pregnancies in North America, Asia and Europe. In Chile it occurs in 2% of pregnancies, while in Sweden it has been reported in up to 14% of pregnant women. It is more common in the last 3 months of pregnancy and with twin pregnancies. It recurs in subsequent pregnancies in 60-70% of women. About half the time it is associated with yellow jaundice. The stillbirth rate and rate of neonatal death associated with fetal distress is increased about 3-4 times.
Causes Of Itching
J Occhipinti and others recently published an algorithm for evaluating the cause of itching during pregnancy, Occhipinti J, Parsey K, Nanda K: A diagnostic and therapeutic approach to pruritus in pregnant women. Prim Care Update Ob/Gyns 1997 4(6):217-23. In it they use the major breakdown as to whether or not skin lesions or a rash is present. Keeping in mind that sometimes scratching that itch can cause a skin rash or lesion, you often find that the itching is generalized and there is no visible cause. In this case you look for general medical diseases such as kidney disease, diabetes, thyroid disease, anemias, lymphomas, parasites and others. If these are not obviously present of suggested by other symptoms, then the next best step is to treat for the most common cause of itching -- dry skin also called xerosis. Moisturizing creams will often cure the problem. If this doesn't work, your doctor will order liver function tests and bile acid levels to make sure you don't have pruritus gravidarum or some other liver disease.
When a rash, not just that from scratching, is present, the main differentiating factor is whether a fever is present. If it is, it can represent chicken pox (varicella), Fifths disease (parovirus) or even a reaction to some drug or medication you are taking. If no fever is present your doctor will need to decide if it is a pregnancy specific skin problem or something that is just coincidental with pregnancy such as eczema, psoriasis or scabies for example. There are some pregnancy specific skin diseases that are quite dramatic but disappear completely after delivery.
| Skin disease | Features | Incidence |
|---|---|---|
| Polymorphic eruption of pregnancy | slightly raised red itchy papules start off and then spread and run together to to form large areas that involve the thighs, upper arms and buttocks. The area around the navel and the face are spared. | 1 in 120-240 pregnancies |
| Herpes gestationis | intensely red and itchy plaques that form large blisters | 1 in 7000 to 50000 pregnancies |
| Impetigo herpetiformis | irregular red skin blotches (not raised) that develope into whitish or greenish sterile pustules. Skin creases are initially affected and then extend out from there. Nails are often affected. | rare |
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