Itchiness in Third Trimester

I am 39 weeks pregnant and for the past two weeks have been itching like crazy -- mostly my arms and legs, not my abdomen. I don't have a rash -- just itching. What can I do?


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

If you are fair skinned or are of Scandinavian heritage, you are a higher risk of developing a condition known as cholestasis of pregnancy. It is characterized by itching and/or jaundice. This can be inherited or sometimes is the body's reaction to estrogen levels. It is a build up of bile salts which are incompletely cleared by the liver and accumulate in the serum of the blood. There are usually no accompanying skin changes with this condition however unless it is from scratching.

Skin changes are fairly common during pregnancy, many of which may be successfully treated with a 1/2 percent hydrocortisone cream. However, because the itching began in the third trimester, I would have your provider run some liver function tests and a bile salt level.

There are some drugs that help this condition and there is some evidence that there is a slightly increased risk of preterm labor and stillbirth in some women with cholestasis of pregnancy. The risk of postpartum hemorrhage may also be increased due to impaired Vitamin K synthesis.

You should seek out the care of a provider who is knowledgeable about this condition and once it has been ruled out, then view it as a dermatological problem that may be treated locally.

Rarely, this condition could be "pruritic urticarial papules and placques of pregnancy" or PUPP, ("itchy, skin bumps") which is a benign dermatological condition of pregnancy. But if you don't have a rash, I doubt this is it.

As always, of course, consult your care provider and good luck with this. It has got to be very uncomfortable.

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