Itchy skin is a common occurrence during pregnancy, and although most of it does not affect the mother and baby, a small percentage of itchy skin is pathological and dangerous to the health of the mother and fetus, so the itch needs to be alert and the cause needs to be identified. Case:When I came out to the clinic on Monday, Ms. He, who was 36 weeks pregnant, said that her skin had been itching for several days, mainly at the stretch marks on her lower abdomen, and sometimes she needed to scratch and scratch to relieve the itch and felt uncomfortable. I carefully gave her a physical examination, blood pressure and heart rate were normal, no yellow staining of the skin or sclera was found, the uterine height and abdominal circumference were within the normal range, the fetal heart rate was 148 beats per minute, the heart sound was strong, the skin of the enlarged abdomen was visible as worm-like stretch marks with some small red rashes, but no other abnormalities such as swelling of the lower limbs were found. Ms. He was confused and asked: What is wrong with me? Does it have any effect on the baby? Environmental climate change Our country is very extensive, the climate is very different, generally in the spring, winter, autumn, many places, the air is relatively dry, coupled with more wind, easy to “take away” the moisture in the skin, at this time, in the middle of the winter season, if you do not pay attention to skin hydration care, often the skin is not so moist, easy to flake, and even The skin has an itchy feeling. In addition, we use the face wash, bath products because of the effect of decontamination, will inevitably wash off some of the skin surface oil, moisture is easily lost, will also feel itchy. If you pay attention to the skin in time to replenish moisture, after washing the face and bathing to apply some skin cream, the symptoms can be significantly relieved. Some pregnant moms are especially careful and afraid to use skin care products, in fact, there is no need to be too anxious. The actual fact is that you’ll be able to wear more cotton clothing during pregnancy, which will also reduce the stimulation of the skin. The other reason for itchy skin is allergy. Once affected by an allergen, a sensitizing process occurs in the body, mostly manifested as a circumscribed reaction, such as itchy skin, rash, edema, etc. Therefore, when identifying the cause of itchy skin, it is also important to think about the presence of allergies. Allergens can be foods, objects (clothing, laundry products, etc.), medications, metals, sunlight, insect bites, and so on. Allergens vary from person to person, the same thing others are not allergic to, you may be allergic to; also varies from time to time, some things are not allergic to before, but now they are. Especially during this special period of pregnancy, it is important to be aware of the occurrence of allergies when eating, using new items, etc. When medication is really needed during pregnancy, it is also important to observe any adverse reactions to the medication. It is never a mistake to be careful! Pruritic papules and plaques of pregnancy This condition is mostly seen in primiparous women, usually after 36 weeks of gestation, with severe itching and lesions mostly occurring at the stretch marks, small red papules, 1 to 2 mm in diameter, which then fuse into larger erythematous spots mostly seen on the abdomen and can extend to the buttocks and femur, the chest and face are rarely affected, often when the stretch marks suddenly increase. It can fade on its own a few days after delivery. The disease does not affect the fetus and the prognosis for the newborn is good. The local symptomatic treatment is sufficient, do not scratch at will, to avoid breaking infection. You can use some topical Furamax lotion, which can significantly relieve the discomfort. Itchy rash of pregnancy syndrome Itchy rash of pregnancy is a skin condition that is closely related to pregnancy. It is a syndrome that occurs easily in the first pregnancy and disappears spontaneously after delivery; it recurs in the second pregnancy and appears earlier and more severely; the patient has polymorphic skin lesions, discomfort around the body, itching, occasional edema, proteinuria, and a high rate of fetal malformations. Most scholars believe that this disease is an autoimmune disease and that the immune mechanism can be transmitted from the mother to the fetus through the placenta, leading to the same disease in the fetus. It is generally believed to be associated with pregnancy, hormonal cyclical changes, and chorionic gonadotropin (HCG). It occurs mostly in the middle of the first pregnancy in women of childbearing age, and rarely in early pregnancy; it can also occur during menstruation and the puerperium. It usually disappears 4 to 16 weeks after delivery. The rash recurs in the second pregnancy and appears earlier and more severe. The rash is often classified clinically as early-onset pregnancy itch (first half of pregnancy) and late-onset pregnancy itch (last 2 months of pregnancy), depending on the time of appearance. The more severe clinical manifestations of the rash may have prodromal symptoms such as discomfort, fever, chills, burning or itching of the skin for several days prior to the appearance of the lesions. The rash usually starts around the umbilicus and spreads to the front of the trunk and extremities, mostly in a centripetal, symmetrical distribution, without involving the mucous membranes. The rash is mostly corn to green bean sized, round, slightly flattened, firm papules on top. It starts as urticaria-like erythema, and on or adjacent to the base of the erythema, herpes or circularly distributed small blisters appear, which may then fuse to form large blisters. The papules are interspersed with a wind cluster. Scratching breaks down to form an exfoliated surface or yellow, bloody crusts with hyperpigmentation. Pregnant mothers usually experience peripheral discomfort such as itching, burning skin sensation, and fever. Occasionally, swelling and proteinuria may occur. Laboratory tests will reveal an increase in eosinophils in the mother’s blood, blister fluid or skin tissue. It is often associated with fetal malformations. The main principles of treatment are to guide the pregnant mother to live a regular life, keep the skin clean and eat less spicy and irritating food. Corticosteroids are effective in severe cases; vitamin B6 supplementation; and topical antipruritic agents can be used for symptomatic treatment. Gestational itch rash itself is not overly dangerous to the pregnant mother and the prognosis is good. However, the fetal malformation rate is higher than normal and the perinatal mortality rate is high in severe cases. Cholestasis of pregnancy Cholestasis of pregnancy is one of the complications of pregnancy that can increase the risk for mother and fetus in severe cases. The prevalence of this disease in our country is clearly regional, for example, it is more common in Jiangsu, Zhejiang and Guangdong, while it is extremely rare in the north, with an ICP prevalence of about 0.8% to 12.0%. The incidence of ICP is sometimes found in pregnant mothers with a history of itchy skin, jaundice, premature birth, fetal growth restriction and unexplained intrauterine death; or a history of allergy to certain drugs or foods; or in family members, especially in mothers or sisters with this disease. Since the liver depends on adequate vitamin K for the synthesis of clotting factors, biliary stasis in patients with ICP prevents the absorption of fat and fat-soluble vitamins, which can easily cause postpartum hemorrhage. The effects on the fetus and newborn include preterm delivery, fetal growth restriction, amniotic fluid fecal contamination, fetal distress, stillbirth and stillbirth, and increased perinatal morbidity and mortality. Unpredictable fetal deaths occur especially in late pregnancy, and intrauterine distress, neonatal asphyxia and perinatal mortality are significantly higher in mothers with ICP jaundice. The clinical manifestations are mainly in late pregnancy and are characterized by pruritus and jaundice and increased serum bile acids, which improve immediately after termination of pregnancy. Pruritus is the most prominent symptom in late pregnancy, often occurring after 30 weeks of gestation. It is mostly located in the abdomen and extremities, and in severe cases it can involve the whole body, and is heavier at night. The symptoms reduce or disappear within 2 to 7 days after delivery. On examination, scratch marks on the skin of the abdomen and extremities are found, but there is no rash; mild to moderate jaundice is seen on the skin, and the jaundice usually disappears completely within 2 weeks after delivery. It is usually not accompanied by signs of acute or chronic liver disease. Symptomatic, hepatoprotective therapy is used to lower blood bile acid levels and relieve generalized pruritus. It is very important to note that fetal monitoring must be strengthened to detect fetal distress and give emergency treatment in time to improve obstetric outcome. It is suggested that bed rest, low-fat diet, and proper sedation can improve symptoms such as itching, and topical itching can be relieved by the use of stove glycolic solution. In severe cases, your doctor will give you medications such as corticosteroids (e.g. dexamethasone), ursodeoxycholic acid, abscessamine, etc., or use herbal treatments (e.g. Yin Chen Tang). In severe cases (regardless of gestational age), you will need to be admitted to the hospital for observation and treatment, while monitoring the fetus. The decision on when to terminate the pregnancy is based on the condition of the mother and fetus. The recovery of bile acids and liver function should also be followed up after delivery. Hepatobiliary system disorders Pregnancy with a combination of hepatobiliary disorders (such as hepatitis, cholelithiasis, cholecystitis, etc.) or pregnancy that triggers liver function impairment, resulting in poor bile flow, often results in discomfort such as itching of the skin. During pregnancy, these diseases need to be screened as well. In summary, we have a general understanding of the possible causes of itchy skin that can easily lead to itching during pregnancy. When itching occurs, we can analyze the possible causes ourselves, but we should still go to the hospital for examination, and sometimes when a rash appears, the obstetrician will also recommend going to the dermatology department to investigate other diseases.