By Ali Weatherford

In one of our weekly support group discussions, a second-time mama shared about being diagnosed with a VERY rare and weird pregnancy condition. It might not surprise you to hear that there are a lot of weird things that can happen to a pregnant body!

You might get the expected weirdness and discomfort like morning sickness, swollen ankles, stretch marks, hemorrhoids, heartburn, constipation, bad sleep, hip pain, back pain, a giant alien belly, and plenty more. You’ll probably need to pee too much and sometimes leak. This is all weird, but expected.

Some itching during pregnancy is also normal and very common, especially around the belly as it stretches. You might even develop stretch marks. This skin stretching can cause some itching, but it’s usually pretty mild and passes quickly or comes and goes. In some cases though, people develop some weirder and much more rare itchy conditions like PG, PUPPS, or Cholestasis.

Itchy and Uncomfortable Conditions which are Not Dangerous

Most itchy conditions are uncomfortable and troubling, but not dangerous.

  • Prurigo of pregnancy is an itchy rash usually on the outside of the joints of the legs and upper arms (knees and elbows) and possibly the belly. This kind of rash is not harmful. It can be uncomfortable though, so a lot of times the symptoms will be managed with steroid creams, oral antihistamines, or other topical creams. This rash usually goes away pretty quickly after birth.
    Pruritic folliculitis looks sort of like acne and it is usually found on the shoulders, upper back, arms, chest, and abdomen. This rash goes away within a month or two after birth.
  • Pemphigoid gestationis (PG) is one I just learned about. I’d never heard of it, because it only occurs in about 1 in 40,000 pregnancies. It seems to be caused by an autoimmune process, and it’s more common in people with light skin. It looks sort of like a poison ivy rash. It appears during pregnancy, usually during the third trimester, and goes away soon after birth. It doesn’t seem to cause any serious health issues, but it’s SUPER uncomfortable and looks scary. The mom I saw shared that the doctors had never seen it before, and it took some time to finally diagnose her. The right medicine is helping keep it under control. The usual treatment involves steroid creams, and when that doesn’t work, a regimen of oral steroids. It usually goes away within a couple of months of giving birth. It can come back in future pregnancies, but not always. When it does recur, it might start earlier and get worse, so make sure to keep an eye on it!
  • PUPPP is one of the most common rash and itchy conditions that can develop in pregnancy. PUPPP stands for Pruritic Urticarial Papules and Plaques of Pregnancy. Phew! I got to see a case of this one a couple of years ago. It is a VERY uncomfortably itchy condition, also rare and weird, but mostly harmless. It looks like a red bumpy rash. The cause is mostly unknown, although there are a few theories. There is some evidence that it is an allergic reaction caused by quick and late stretching of the skin. It often starts in the stretch marks and then can take over. It’s a lot more common when people are carrying multiples and when people gain a lot of weight. Both of those things mean more stretching of the skin. Fortunately, even if it does continue through the pregnancy, it will definitely go away after. It’s rare for it to last more than 4 weeks, and it’s not likely to come back in future pregnancies. It’s just one of those weird pregnancy things.

Potentially Dangerous Condition

Then there’s an itchy pregnancy condition that can be very uncomfortable AND potentially dangerous. If you experience any of the symptoms of this condition, let your care provider know quickly.

Cholestasis is an itchy condition that has come up a couple of times listening to birth stories, so I thought I’d mention it here. It’s caused by an issue with the liver. When caught early enough, it can be managed well, but it might mean induction a couple of weeks before your due date. This condition is rare and weird like the others, but this one can cause some complications, so diagnosis and treatment is important. Something extra strange about this one is that the itching occurs without the appearance of a rash, and often on just the hands and feet.

The cause of Cholestasis is mostly unknown. It seems to be pretty complicated, but there could be a genetic component and a relationship with very high estrogen levels. It may also be more common in people with selenium and vitamin D deficiencies.

Cholestasis usually comes on late in the 2nd trimester or the first part of the 3rd trimester, usually after 30 weeks. The itching is most commonly on the palms of the hands and soles of the feet and might be worse at night. Some people will also have other symptoms like nausea, fatigue, insomnia, pain in the top right area of the belly, darker urine, and lighter colored poo. Some people might even notice some yellowing of the skin and eyes (jaundice). For most people though, the itching is the main or only symptom.

To diagnose it, doctors will usually order some blood work to test your liver function. If you have the classic Cholestasis itching along with certain lab values, you might be diagnosed with it. At that point, it’s most likely that you’d receive regular doses of a medication that usually improves liver function and reduces itching.

Within a couple of weeks, most people see a lot of improvement. The drug of choice seems to be very safe for babies and is most often effective. There are other medications that can be tried if the first doesn’t work, and most often, early delivery is recommended. Depending on the liver function tests, it might be recommended sooner or later. Most often, induction would be recommended between 36-39 weeks.

What Can You Do About Being Itchy While Pregnant?

If you develop an issue with itching or a rash during pregnancy, I’m so sorry! It’s a good idea to tell your care provider even if you know it’s not something dangerous. If they can give you a clear diagnosis, it might help you find some remedies to ease the discomfort. Depending on what kind of itching you’re having, certain things might work well or not at all. It always helped me to remember that these kinds of things will not last forever! In the worst case, you will almost definitely see it resolve after your baby comes.

It feels unfair to me that some people have to go through so much during pregnancy! Some people seem to sail through it without much discomfort, but most people experience a long list of pregnancy irritations. Isn’t it enough to have to carry around a giant belly and push a baby out? That’s already a lot of work!

Fortunately, most pregnancy symptoms are harmless. Unfortunately, a lot of them also don’t have a good cure. You might just have to bear with it until it passes or until the pregnancy is over. I like to think that all of these discomforts make birth seem like a great alternative. Instead of dreading birth, some people start to look forward to it because it will be a relief from these discomforts!

References

Pemphigoid Gestationis
PUPPP
Cholestasis
Descriptions of Pregnancy Rashes/Itching

Our articles are not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.

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