Itching during pregnancy is a pathological condition that is a symptom of various diseases that have arisen or worsened during gestation. It is manifested by a feeling of painfully tickling irritation of the skin and mucous membranes, which causes a scratching reflex. There may be a rash, other skin symptoms, signs of damage to various organs and systems. It is diagnosed using biochemical, immunological, hormonal, allergological, microbiological studies, PCR, ELISA, ultrasound. Antihistamines, corticosteroids, emollients, sedative herbal remedies are used for the pathogenetic and symptomatic treatment of itching.
L29.8 Another itch
According to the observations of obstetricians and gynecologists, temporary or permanent itchy sensations of varying intensity occur in more than half of pregnant women. 45-50% of patients complain of genital (intimate), 18-22% — skin, 8-10% — anal itching. In some women during pregnancy, the simultaneous appearance of different types of itching is noted. Usually, the disorder develops as a result of exacerbation of existing diseases. In some cases, the cause of diseases, the symptom of which is itching, are changes that occur during pregnancy. The urgency of timely diagnosis of pathology that caused itching of the skin or mucous membranes is due to the risk of serious obstetric complications in some pathologies.
Specialists in the fields of obstetrics name many factors that can provoke the occurrence of itchy sensations in pregnant women. Itching can manifest diseases that have worsened or occurred in the gestational period, systemic responses of the body to the action of exogenous agents and endogenous metabolites. The most common causes of the disorder are:
- Skin and fungal diseases. Itching is observed in atopic and contact dermatitis, dermatophytosis, simple chronic lichen, psoriasis, seborrhea, eczema. Itchy sensations are characteristic of parasitic skin lesions — head and pubic pediculosis, scabies. In the cold season, itching accompanies the development of xerosis. In many patients, these disorders are detected even before pregnancy, although infection with skin parasites or the manifestation of pathology is possible during gestation.
- System processes. Itching is accompanied by endogenous intoxication with natural and pathological metabolites in some forms of oncopathology (Hodgkin’s lymphoma, true polycythemia), liver diseases with cholestasis (viral hepatitis, cholelithiasis, hepatosis), endocrinopathies (diabetes mellitus, hyperthyroidism, hypothyroidism), iron deficiency anemia, terminal renal failure with glomerulonephritis, pyelonephritis, hydronephrosis, nephrolithiasis.
- Genital infections. Often they are manifested not by skin, but by intimate itching, which occurs due to irritation with toxins, and pathological secretions (whites). The symptom is more pronounced in candidiasis, genital herpes, gardnerellosis, chlamydia, gonorrhea. Decreased immunity and hormonal changes characteristic of pregnancy often lead to the development of bacterial vaginosis, one of the signs of which is itching in the genital area.
- Urological and proctological diseases. Itching in the perineum is caused not only by intense vaginal whiteness, but also by irritation with urine during frequent urination in pregnant women with urethritis, cystitis, pyelonephritis, pathological changes characteristic of hemorrhoids, anal fissures, local perianal dermatitis. One of the causes of anal itching is enterobiosis, a helminthic invasion in which part of the parasite’s life cycle is associated with skin lesions near the anus.
- Exogenous effects. The influence of the pathological agent can be external (through the skin and mucous membranes) and internal (after absorption in the gastrointestinal tract). In both cases, it is possible to develop an allergic or toxic systemic reaction with itching of varying intensity. The provoking factors are most often drugs (aspirin, antibiotics, anesthetics), food, plant pollen, animal hair, dust, insect bites.
- Neurological and mental disorders. Tingling, paresthesia, intermittent intense itching caused by changes in the peripheral nervous system may be early signs of multiple sclerosis, preceding the main neurological symptoms. Neurogenic itching can be a consequence of stress, a sign of postherpetic neuralgia, brain tumors. In rare cases, itching manifests itself within the framework of tactile hallucinosis.
- Dermatoses of pregnant women. In 1.5-3.0% of patients, as a rule, having a hereditary predisposition, physiological changes during pregnancy (stretching of the skin with damage to connective tissue, hyperestrogenism, restructuring of immunity) provoke an allergic reaction or intrahepatic stagnation of bile. As a result, one of the specific gestational itchy dermatoses develops — atopic dermatitis, pemphigoid, cholestasis of pregnant women.
Probable prerequisites for a more frequent appearance of itching in various diseases in pregnant women are increased dryness of the skin as a result of the influence of progesterone, a physiological decrease in immunity aimed at preserving gestation, stretching and tearing of connective tissue fibers of the skin with the formation of autoantigens, violation of the natural microflora of the vagina. Pregnancy also serves as a trigger for the development of a number of diseases accompanied by itching — gestational diabetes, postpartum autoimmune thyroiditis, etc. Additional risk factors are considered to be obesity, wearing synthetic clothing and underwear, the use of flavored pads and irritating alkaline products for skin and genital care, non-compliance with personal hygiene rules, the use of spicy food with seasonings, spices.
The mechanism of itching during pregnancy depends on the causes that caused it, but the key link in the pathogenesis in all cases is the irritation of certain areas of the afferent pathways that transmit nerve impulses. Most often, itching occurs due to stimulation of peripheral nociceptors. The receptor apparatus is usually affected by mediators formed during a local inflammatory, allergic, autoimmune reaction, microbial toxins, metabolites (bile acids, nitrogenous compounds, glucose in high concentrations), medications.
It is possible to develop itchy sensations due to injuries in which the inflammatory reaction is secondary, permanent local effects (insect bites, movement of helminths, irritation with urine, whites). Sometimes pathological afferentation, characteristic of itching, is noted against the background of microcirculatory disorders (for example, in diabetes mellitus), lesions of sensitive nerve fibers (in multiple sclerosis). In case of volumetric neoplasms of the brain, strokes, neurotic and mental disorders, the focus of pathological impulses, subjectively perceived as itching, is localized in the central parts of the nervous system.
The main sign of the disorder is local or generalized itchy sensations of varying intensity, from slight tingling and burning to an unbearable desire to scratch or rub the skin, mucous membranes. Depending on the causes against which itching has arisen, it can be permanent or periodic, serve as the only sign of the disease or be accompanied by other skin manifestations — redness, scratching, macular, papular, vesicular, pustular rash, peeling. In general, the clinical picture is characterized by significant polymorphism, determined by the leading pathology, the symptom of which was skin or intimate itching.
Diseases with intense itching can be complicated by secondary infection of excoriation sites. The likelihood of obstetric complications depends on the effect of the underlying disease on pregnancy. Most skin diseases, transient allergic reactions, dermatoses of pregnant women cause discomfort and worsen the quality of life, but do not pose a serious threat to the woman and fetus. With severe cholestasis of pregnant women, many systemic processes increase the likelihood of gestosis, spontaneous miscarriage, premature birth, fetoplacental insufficiency, fetal development delay, labor anomalies, coagulopathic bleeding, DIC syndrome. Possible complications of infectious diseases occurring with itching are chorioamnionitis, intrauterine infection of the fetus, postpartum endometritis, obstetric peritonitis.
The main task of the diagnostic search when a patient complains of itching of the skin, genitals, and perianal area is to identify the cause that caused the disorder. A wide range of laboratory and instrumental diagnostic methods are used to diagnose the condition of various organs, systems, and to detect biochemical markers of the disease. In addition to gynecological examination, general blood and urine tests during pregnancy are recommended:
- Biochemical blood analysis. Indicative for some diseases are data on the level of glucose, bile acids, total bilirubin, cholesterol, triglycerides, serum iron, urea, uric acid, creatinine, enzymes (AlT, AsT, alkaline phosphatase), the composition of blood protein fractions.
- Hormonal studies. To exclude endocrinopathies manifested by itching of the skin, mucous membranes, an index of insulin resistance is used, an assessment of the content of insulin, TSH, thyroxine, triiodothyronine, thyroxine-binding globulin in the blood. In some cases, the level of sex hormones is determined.
- Investigation of immune and allergic status. Confirmation of the atopic nature of the disease is an increased concentration of IgE, histamine in the blood. In some disorders, specific markers of autoimmune processes are detected (antibodies to collagen, AT-TPO, AT RTG).
- Diagnosis of infections. Highly sensitive methods for detecting infectious diseases are polymerase chain reaction, ELISA. With their help, you can detect signs of genital herpes, candidiasis, chlamydia, mycoplasmosis, ureaplasmosis, and other urogynecological diseases.
- Seeding of the separated urogenital tract. Microbiological examination allows not only to determine the causative agent of an infectious disease, but also to assess its sensitivity to antibacterial drugs. The method is especially indicated for patients with itching of the vulva, vagina, urethra.
In the presence of rash elements, an analysis of scraping or skin discharge is performed. To assess the morphological state of various organs, ultrasound diagnostics is used that is safe for the fetus — ultrasound of the kidneys, liver, gallbladder, and pelvis. Chemical and toxicological analyses, histological examination of biopsies, scraping for enterobiosis, analysis of feces for helminth eggs can be recommended as additional methods. Differential diagnosis is usually carried out between diseases in which itching occurs during pregnancy. In addition to an obstetrician-gynecologist and dermatologist, according to indications, the patient is consulted by a venereologist, an infectious disease specialist, an endocrinologist, a gastroenterologist, a hepatologist and a urologist.
When developing tactics for the management of a patient with complaints of itchy sensations, the effect of the underlying disease on gestation is taken into account. In most cases, it is possible to prolong pregnancy until the time of physiological childbirth. The treatment regimen is determined by the protocol for the corresponding disorder, may include antibiotics, hormones, antifungal, hormonal, anticonvulsive drugs, drugs from other pharmacotherapeutic groups, taking into account their possible effect on fetal development. To reduce or eliminate itching, nonspecific pathogenetic and symptomatic therapy is effective:
- Antihistamines. Due to the blockade of histamine receptors, the transmission of excitation along sensitive C-fibers decreases, and the release of mediators by mast cells decreases. Suppression of an allergic reaction can significantly reduce the intensity of itching or completely stop it.
- Glucocorticoids. Local application of corticosteroid ointments, creams, emulsions has a pronounced antipruritic effect. Local treatment is more effective with limited dermatitis and dermatoses. Taking into account the possible effect on the fetus, systemic corticosteroids are used only limited during gestation.
- Emollients. Since the skin becomes drier during pregnancy, which increases itching, its moisturizing and softening have a positive therapeutic effect. The products of this group also make it possible to accelerate the restoration of damaged epidermis and lipid intercellular structures of the skin.
- Sedative phytopreparations. Due to the mutual influence of itching and emotional disorders (bad mood, irritability), the appointment of sedative fees makes it possible to reduce the intensity of perception of uncomfortable sensations at the level of the central nervous system. Sedative therapy also contributes to the normalization of disturbed sleep.
The patient is advised to exclude from the diet foods that increase irritation or can cause allergies, normalize the drinking regime, have enough rest, avoid stress. Usually, natural delivery is recommended for pregnant women with itching. Caesarean section is performed only if there are obstetric indications.
Prognosis and prevention
In the absence of systemic diseases, the outcome of pregnancy in women with itching is usually favorable. The prognosis worsens when serious somatic diseases, endocrinopathies are detected. For preventive purposes, patients suffering from skin and other pathologies should take into account the recommendations of a dermatologist and specialized specialists when planning a pregnancy. Pregnant women without concomitant pathology are recommended to carefully observe the rules of personal hygiene, abandon synthetic underwear, moisturize the skin with natural remedies, avoid situations in which sweating increases sharply — staying in stuffy rooms, overheating in the sun. For washing laundry and clothes, it is better to use phosphate-free neutral washing powders.