II. Epidemiology
- Occurs more commonly in Primigravidas
- More common in third trimester
- Incidence: 0.4 to 0.6% of pregnancies
III. Pathophysiology
- May be related to Abdominal Distention
IV. Risk Factors
- Increased maternal weight gain
- Fetal Macrosomia
- Twin Gestation
- Primigravida
V. Signs
- Characteristics
- Distribution
- Onset over Abdomen in 90% of cases (especially within Striae Gravidarum)
- Symmetric spread to thigh and buttock
- May also involve upper arm, back, and hands
- Does not involve face or periumbilical area
- Contrast with Pemphigoid Gestationis (which does not spare the umbilical region)
VI. Differential Diagnosis
- See Pruritus in Pregnancy
- See Pruritus Causes
- Erythema Multiforme (target lesion)
- Herpes Gestationis
- Pemphigoid Gestationis
VII. Management
- See Nonspecific Management of Pruritus
- Cool compresses
- Oatmeal Baths (e.g. Aveeno)
- Antihistamines (e.g. Hydroxyzine)
- Refractory, severe cases of intolerable itching
- Topical Corticosteroids (Group V)
- Consider short course of Prednisone 40 mg orally daily
VIII. Course
- Onset in third trimester or early postpartum
- Severity decreases within one week of onset
- Rash and symptoms persist on average 6 weeks
- Resolves after delivery
- Typically does not recur in subsequent pregnancy (unless Multiple Gestation)
IX. Complications
- Not associated with adverse fetal effects
X. References
- Gabbe (2002) Obstetrics, Churchill Livingstone, p. 1288
- Habif (1996) Dermatology, Mosby, p. 140
- Erlandson (2023) Am Fam Physician 107(2): 152-8 [PubMed]