Stretch Marks in Pregnancy

Striae gravidarum (stretch marks) are purplish red streaky scars which appear when the skin is overstretched. They appear during pregnancy over the abdomen where the skin is supple, usually in the third trimester or the later months of pregnancy when the skin is maximally stretched to accommodate the growing fetus and also over the breast but more so during the period of breast feeding when the breasts swell up and increase much in size. Apart from these areas, striae are also seen on the hips, buttock and inner and outer thigh. Up to 90% of women develop stretch marks over some part of their body (70-90% over the abdomen) due to the excess weight gain of pregnancy. Most lightly skinned women have pinkish colored striae and the dark skinned have striae that are lighter than the surrounding area. Most women start to worry about striae /stretch marks after they have their baby. A little attention to the rate of weight gain and skin stretch during the pregnancy period will definitely go a long way in reducing them. The more weight gained during pregnancy, the more likely are you to develop them. In some women, the changes in weight are drastic and happen very rapidly and this causes a sudden stretch of the skin and the dermal protein tissue tears. This initially appears pinkish and later fades to a white silvery scar which remains as a stretch mark. Women who have big babies or women with a twin/multiple pregnancy have more chances of having striae as their skin is stretched more due to the extra space needed to accommodate more than one fetus.

The likelihood of having striae increases if one has had them during the pubertal period or in a previous pregnancy and if one gains weight more than what is recommended or has a general malnourishment. The women who have a lot of striae should report this to their doctor as they might be prone to having more vaginal lacerations and tears during a normal vaginal delivery as her dermal matrix has a weak protein framework as suggested by the large number of striae or deeper indented striae on her abdomen.

The skin over the abdomen is supple and has fat deposition underneath and sudden loss of weight after the baby is born makes the skin loose and the striae appear prominent at that time which is when most women start worrying about them. Normally after pregnancy, these stretch marks fade away slowly as the body comes back to normalcy and is repairing all the tissues. Usually after12 months post-partum (after delivery) these marks fade away or are much lighter than before.

Steps to take for Prevention

1. Many women use creams, moisturizers, lotions etc. during their pregnancy to prevent stretch marks and worry about them constantly. Enjoy your pregnancy rather than worrying about them. Instead, concentrate on gaining the recommended amount of weight,( between 25 – 34 pounds), in a graded manner.
2. Eat a good nutritious diet and avoid fattening foods. Eat food rich in proteins as this would strengthen the protein framework of elastin and collagen in the skin.
3. To avoid stretch marks over the breasts, try wearing a supportive maternity bra specially made to give extra support for the heavier breasts during pregnancy and in the lactation period
4. Topical reams containing retinol or retinoic aid should be avoided during pregnancy and their safety during lactation period has not been established..

Treatment options

Most stretch marks as already said above fade away with time but for those which
do not there are some options for treatment as below.

• Topical applications

  Retinoic aid/Retinol containing creams derived from Vitamin A. Their efficacy is not proved but some do experience benefit from them

• Chemical peels

  which include Glycolic acid peel, Trichloroacetic acid etc. These peels remove the superficial layers of the skin and can also be used on the face, neck and over the back of the hand.

• Lasers

  Laser treatment for stretch marks is done by dermatologists with moderate improvement after a few sittings.

Remember that pregnancy is a wonderful and joyful period in a woman’s life and
is to be enjoyed by her without worrying unduly about these marks. However the
simple measures outlined above would help in preventing them.

Research for better and more definite treatments for stretch marks is already underway and it would not be long before we can treat them in a better and a more definitely way.