Articles

Key takeaways

• Many common skin changes happen due to hormones and skin stretching.
• Protect your skin from the sun to help manage darkening patches.
• Moisturisers can make stretch marks feel more comfortable.
• Seek medical advice for severe itching or new, spreading rashes.

Common skin changes in pregnancy and what causes them

Pregnancy brings many changes to your body, including your skin. These changes are often due to shifting hormone levels and your skin stretching.

Stretch marks (striae gravidarum)

Stretch marks are narrow, streak-like lines on your skin. They can be pink, red, purple, or brown.

The exact colour depends on your skin tone. Around 8 out of 10 pregnant women get them.

They usually appear on your:

• tummy
• upper thighs
• breasts
• hips
• buttocks

They happen as your pregnancy progresses and your bump grows. Stretch marks occur when the middle layer of skin (dermis) stretches and breaks in places.

Hormonal changes in pregnancy can make you more likely to get them. Your skin type also plays a role, as some skin is more elastic. You are more likely to get stretch marks if your weight gain is more than average during pregnancy.

Linea nigra

You may notice a dark line that appears down the middle of your tummy (linea nigra). This affects 9 out of 10 pregnant women. This line usually disappears completely after your baby is born.

Melasma

Darkening patches on your face are a common skin condition during pregnancy. This is sometimes called the 'mask of pregnancy' (melasma). This usually goes away in 7 out of 10 women within a year of pregnancy.

Other skin changes

Hormonal changes can also make your nipples and the area around them darker. Your skin colour may darken a little in patches or all over.

Birthmarks, moles, and freckles may also become darker. These changes will gradually fade after your baby is born, though your nipples may stay a little darker.

Spots on your skin can increase, improve, or stay the same during pregnancy.

Safe ways to manage your changing skin

There are safe ways to manage common skin changes during pregnancy.

Managing melasma

To help reduce these darkening patches, protect your skin from the sun.

Mineral sun creams use ingredients like titanium oxide and zinc oxide, and they work by sitting on top of your skin. Chemical sun creams work by being absorbed into your skin. Both are safe to use in pregnancy, so you can choose whichever you prefer.

Protecting yourself from UV rays is important to prevent melasma from worsening. You can do this by avoiding the sun.

Wear a wide-brimmed hat when you are outside. Use sun cream with factor 30 or above and a high UVA rating.

If you sunbathe while pregnant, you may find you burn more easily. Protect your skin with a high-factor sun cream. Do not stay in the sun for a long time.

Managing stretch marks

After your baby is born, stretch marks usually fade over time. However, they do not disappear completely and may leave lines on the skin.

There is no evidence that applying cream or oil to the skin will prevent stretch marks. A normal moisturiser may make them feel more comfortable.

Most women gain about 10 to 12.5kg (22 to 28lb) in pregnancy. How much weight you gain depends on your weight before pregnancy.

It is important not to try to lose weight by eating less when you are pregnant. You need to have a healthy diet.

If you are worried about your weight, talk to your midwife or GP.

Hydration and general skin care

Drink plenty of non-alcoholic, caffeine-free drinks during the day to stay hydrated. If you are out or exercising in warm weather, take water with you.

You can also carry a water spray to cool yourself quickly. Another tip is to put your wrists under cold running water.

It's important to avoid acne treatments that contain retinoids while you're pregnant. If you currently use a product with retinoids, discuss this with your GP or midwife about safer alternatives.

When to talk to your doctor about skin changes

Itching in pregnancy is common. It can be caused by hormone changes and your skin stretching. This itching usually stops after you have had your baby.

Non-urgent advice for itching

See a GP if you are pregnant and have itchy skin that affects your daily life. Also see a GP if it does not get better after treatment from a pharmacist or if it keeps coming back.

Speak to your GP if you have eczema that worsens during pregnancy. Also contact them if you notice a new rash, lump, or swelling. These symptoms are usually not harmful in pregnancy, but a GP can offer advice and treatment.

Urgent advice for severe itching

Get urgent medical help if you have very itchy skin that keeps you awake at night. This is also true if the palms of your hands or soles of your feet are itchy or if the itching is worse at night.

These could be signs of a liver condition that can happen in pregnancy (intrahepatic cholestasis of pregnancy, or ICP). This condition often requires urgent assessment and treatment.

Call your maternity unit if you have their phone number. If you cannot contact your maternity unit, call 111.

Understanding intrahepatic cholestasis of pregnancy (ICP)

Intrahepatic cholestasis of pregnancy (ICP), sometimes also called obstetric cholestasis, is a liver condition that can develop during pregnancy. It often causes itching which can be mild or severe. The hands and feet are usually affected, but other areas may be itchy too. The itching may be particularly bad at night.

It's important to get checked for this condition. Without treatment, it can sometimes lead to complications such as your baby being born too early (a premature birth) and there is also a small risk of stillbirth if ICP is severe. If you develop ICP during your pregnancy, a care plan will be agreed with you and your team to keep you and your baby as healthy as possible. As part of this care plan you will likely get extra appointments to be monitored and follow up blood tests. You’ll usually be offered a treatment to treat your liver and help reduce the itching. Depending on how severe your ICP is and how you respond to treatment, your midwife and doctor may recommend starting labour early to reduce the risk. Most people with ICP make a full recovery after pregnancy and have a healthy birth.

Rare skin conditions

A rare but serious condition causes an itchy rash on the tummy that spreads and may form blisters (gestational pemphigoid also known as pemphigoid gestationis, or PG). It's important to get medical help, as treatment can help manage the rash and support your baby's healthy development.

A very rare skin condition that causes inflamed patches with small spots containing pus (impetigo herpetiformis) can sometimes appear in the third trimester. It is usually only mildly itchy. However, you might also feel unwell with symptoms such as:

• Fever
• Chills
• Upset stomach (including diarrhoea or vomiting)

It's important to get medical help straight away, as treatment is available to keep you and your baby safe.

If you have an itch with a rash, contact your GP or midwife.