Skin, hair and nails undergo a lot of changes during pregnancy. They can have an impact on the appearance, self-esteem and body image for many women. This article outlines some of the normal changes and their underlying causes.
A discussion on pregnancy skin changes is incomplete without the so much-talked-about ‘pregnancy glow’.
Many believe that pregnancy glow is a must-have for a healthy pregnancy and birth outcome.
Some women become very worried if they do not notice this ‘glow’ and start thinking that its absence may indicate a pregnancy complication.
Pregnancy glow is a lay term to describe the skin looking bright and shiny (especially on the face) during pregnancy.
This happens due to a combination of factors:
Increased secretion of the oily sebum from the sebaceous glands on the skin.
Increased blood circulation on the skin
The appearance and intensity of the so-called ‘Pregnancy glow’ depend on several factors such as the skin complexion, exposure to sunlight and genetic composition.
Every woman’s skin responds differently to physiological pregnancy changes. Therefore, some show obvious ‘glow’ than the others.
Pregnant women should be reassured that any obvious absence of ‘Pregnancy glow’ is not a sinister sign of pregnancy complication.
Let us now delve down deep into some details of other changes:
Excessive skin pigmentation (called ‘hyperpigmentation’) is the most common skin change during pregnancy (especially during the affecting 85% – 90% of women.
This happens typically during the late second trimester and third trimesters. However, it may occur early.
The individual skin complexion depends on the density of the pigment, melanin. A special cell in the skin (called melanocyte) secretes melanin.
The exact cause of this hyperpigmentation is not known.
The following may contribute:
1. Over-activity of the melanocytes
The melanocytes may be stimulated during pregnancy due to the increased levels of estrogen, progesterone, β-endorphins and α- and β-melanocyte-stimulating hormones.
2. Over-production of melanin by the melanocytes:
– Increased activity of the enzyme tyrosinase
– Genetic predisposition
– Exposure to sunlight (ultraviolet rays)
Skin hyperpigmentation commonly occurs in areas such as nipples, areolas, vulva, perineum, skin folds and inner thighs.
This may result in the following well-known changes:
Also known as melisma (previously called chloasma), a ‘pregnancy mask’ is the hyperpigmentation of face and may occur up to 70% of pregnant women. This is most noticeable in women with darker skin.
In medical terms, this known as the Linea nigra.
This is the appearance of a dark vertical line in the abdomen between the belly button and the pubic bones.
Changes in connective tissues (collagen) of the skin
9 out of 10 pregnant women may develop stretch mark (also known as ‘Striae gravidarum’) in different parts of the body (mainly in the abdomen, breast areas, buttocks, hips and thighs).
They appear most commonly in the late second or third trimester of pregnancy.
Striae usually start as flat pink or purple bands on the skin surface. This early stage is called striae rubra.
Then it turns into violet-red bands and appears longer, wider and raised from the skin surface. This mature stage is known as striae alba.
Striae can cause itching and discomfort.
Sometimes this can cause distress due to cosmetic reasons and result in body image problems.
What are the causes of the stretch marks?
The exact cause is not known but the following may contribute:
The middle layer of the skin (‘dermis’) is primarily made of a network of collagen tissues fibres.
The skin elasticity and strength depends on the amount and density of collagen.
Stretch marks primarily happen due to the separation of the collagen tissues in the skin due to overstretching (as a result of growing fetus, enlarged breasts, weight gain and accumulation of body fat).
Overstretching results in separation or breaking of collagen fibres which results in stretch marks.
It may be worse if there is excessive weight gain during pregnancy.
Increased levels of estrogen, relaxin and corticosteroids are believed to weaken the adhesiveness between the collagen fibres.
As a result, the fibres separate leading to the formation of stretch marks.
Some women may have less elastin and fibrillin fibres in their skin or they may be reduced during pregnancy. These fibres are known to increase the strength and elasticity of the skin.
Do the stretch marks disappear?
After the childbirth, the stretch marks fade over a period of time but may not disappear completely.
Can you prevent the occurrence of stretch marks in the first place?
There is no robust scientific data to suggest that stretch marks can be prevented completely.
The following may help to prevent or reduce severity:
1. Avoid excess weight gain through a healthy balanced diet and exercise
2. Ensure good nutrition, especially fruits and vegetables (containing vitamin C)
3. Drink plenty of water (as dehydrated skin is a risk factor)
4. Studies suggested that massage with creams containing Centella asiatica extract, vitamin E and collagen-elastin hydrolysates (such as Trofolastin cream) may be helpful.
5. Almond or olive oil applied with daily massage or massage alone may be helpful.
There is no definite scientific evidence to show that the use of olive or almond oil or cocoa butter on their own is helpful.
6. Creams containing hyaluronic acid (such as Alphastria and Verum cream) have been shown to be effective in some studies.
Before applying any skin cream during pregnancy, always check the label to ensure its safe for pregnant women. There is also a risk of allergy and contact dermatitis reaction with any cream.
Is there any treatment of stretch marks?
There is no effective treatment of stretch mark is available.
The scientific data on the success of various treatment options is mixed and inconclusive.
The following have been tried to treat stretch marks:
This is related to vitamin A and should be avoided during pregnancy due to the risk of birth defect.
Hydrant creams and moisturisers
There is no data to suggest that these creams/ lotions are effective on their own.
Natural/ herbal remedies
Although there are some anecdotal reports of success, there is no robust scientific data to show the effectiveness of natural remedies alone in the treatment of stretch marks during pregnancy.
Some commonly used unconventional therapies include olive oil, sweet almond oil, wheat germ oil, castor oil, avocado oil, eucalyptus tree oil and seaweed wraps.
Further research and clinical trials should be conducted to establish the efficacy and safety of such treatments.
Glycolic acid (GA) and Trichloroacetic acid (TCA)
There is no robust data available in the scientific literature for their safety and effectiveness.
This is becoming more popular in the treatment of stretch marks in general for cosmetic purposes.
At present, the robust scientific data on the safe use of laser treatment during pregnancy is available and should be avoided.
This treatment should be attempted after childbirth. However, even after laser treatment, the stretch marks may not be completely removed. It could be expensive too.
Changes in sweat glands
There two types of sweat glands on the skin:
Eccrine glands which secrete sweats in the forehead, palms of hands and soles of feet.
Apocrine glands secrete sweats in the underarms, nipples, anus and pubic area.
During pregnancy, the activity of all the eccrine glands (except pals of hands) increase and the activity of the apocrine glands decrease.
This may result in increased sweating (‘hyperhidrosis’) during pregnancy.
Changes in sebaceous glands
Sebaceous glands are commonly found on the scalp, forehead, face, chest and back. They secrete an oily substance called sebum.
The activity of these glands increases during pregnancy.
They may result in small papules on the areola, called Montgomery tubercles. They help to lubricate the areola and nipples during breastfeeding.
There are conflicting reports in the scientific literature whether acne (also called acne vulgaris) improves or deteriorates during pregnancy.
During first trimester acne often improves but may worsen during the third trimester of pregnancy.
Causes of worsening acne during pregnancy:
1. Increased levels of androgen (male hormone)
2. Increased sebum secretion due to the high activity of sebum glands
3. Treatment of acne during pregnancy:
Safe treatment options for mild acne (during pregnancy) are:
Acne without infection: topical preparations containing azelaic acid or benzoyl peroxide.
Acne with inflammation: topical preparations containing a combination of benzoyl peroxide and erythromycin or clindamycin.
Moderate to severe condition:
erythromycin or cephalexin tablets. Prednisolone may be needed in severe cases.
Changes in the blood vessels
4 out of 10 women may develop varicose veins. This may affect legs, vulva, vagina and anus and make haemorrhoids worse.
The uterus may partially block the large vein (vena cava) situated in from of the spine.
As a result, the return of blood from the legs to the heart slows down. This leads to increased pressures and swelling on the small veins (called varicose veins).
Varicose veins may be painful at times.
Rarely, they may increase the risk of blood clots in the veins (called deep vein thrombosis).
What is the treatment of varicose veins?
In most of the time, they disappear after the childbirth.
The following could help during pregnancy:
1. Avoid prolonged sitting or standing (especially at work)
2. Sleeping on the left side.
3. Elevating the legs when resting
4. Elastic compression stockings
Pain in the calf muscles during pregnancy should not be neglected. Please seek medical advice to exclude a deep vein thrombosis.
The following changes can occur:
1. Abnormal excessive hair growth (‘hypertrichosis’) on some parts of the body, especially along the vertical line between the pubic bone and the belly button.
2. Excessive growth of hair on face, chest and back of the pregnant woman. This male pattern of hair growth is called hirsutism.
3. Thickening of scalp hair during pregnancy.
4. Increased hair loss after 1-5 months of childbirth. This may continue 1-2 years after the baby is born.
Up to 4 out of 10 pregnant women may develop noticeable nail changes.
Some of the changes are as follows:
1. Increased growth of nails
2. Grooves across the nails
3. Nails may become brittle
4. Separation of nails from the nail bed (called ‘onycholysis’)
5. Pigmentation of the nail.
What should be done in the care of nail during pregnancy?
1. A healthy balanced diet including an adequate source of biotin (vitamin B7) which is important for healthy nails.
2. Trimming of nails as long nails may break
3. Many researchers suggest avoiding nail cosmetics during pregnancy.
4. Avoid biting nails.
5. Always dry up the hands and nail properly after handing water as wet nails may become brittle easily.
6. Use gloves when handling water if possible, such as washing dishes.
7. If an ingrown nail is giving trouble then get advice from a healthcare professional.
8. Avoid artificial nails, if possible, during pregnancy.