Why your skin changes with pregnancy

With pregnancy comes a number of changes in the body. Many physical changes, including changes in skin, are completely normal and important to enable a healthy birth outcome for both mom and baby. A Baylor College of Medicine obstetrical and maternal-fetal medicine expert highlights how to care for your skin during pregnancy.

Changes in pigmentation and hyperpigmentation are common, and the pregnancy hormones of estrogen and progesterone are assumed to be the culprits of hyperpigmentation in pregnancy. Increasing levels of the melanocyte-stimulating hormone that occurs in pregnancy can also drive some hyperpigmentation changes. Placenta lipids, or bioactive molecules, can increase pigmentation.

“There are a number of changes to the cells in the skin that lead to hyperpigmentation changes, all of which are very common in pregnancy,” said Dr. Kjersti Aagaard, professor of obstetrics and gynecology in maternal-fetal medicine at Baylor and Texas Children’s Hospital.

Linea nigra, a dark line that runs up from the pubic bone, is a common example of a type of hyperpigmentation change that can occur. Linea nigra can also occur around the areola and vulvar regions.

Some pregnant women might try to use bleaches or other products for the darkening pigmentation, but Aagaard advises against this.

“This is a natural phenomenon that occurs and much of it will resolve after pregnancy – never all the way – but it’s part of the joy and privilege of carrying on the next generation,” she said. “You won’t look or be the same before and after pregnancy.”

Rosacea and melasma

Rosacea is a skin condition that causes redness, blotchiness and acne breakouts. This occurs over the cheeks, nose, forehead and chin. People often want to use medications and treatments that target the retinoic acid receptors to treat rosacea, but experts recommend avoiding them.

“Because of the combination of adaptive physiologic changes that accompany pregnancy, pregnant folks are especially sensitive to sun exposure. Lightweight and breathable fabrics that cover the skin and using a good sunblock with at least 15 SPF or higher while wearing a hat is the best thing to do.” Aagaard said.

Melasma, or macular hyperpigmentation, is usually limited more to the face, appearing on the cheeks, over the nose and up to the forehead, causing splotchy, darkened regions. Melasma is common and can occur in pregnant or nonpregnant people. It might also appear when taking oral contraceptives or hormonal creams. Sunscreen usage and skin coverage is crucial since pregnant women are more sensitive to melasma during pregnancy. Aagaard also recommends wearing a hat and covering the neck to reduce melasmic changes, regardless of skin tone. Melasma will fade over time, but will never entirely disappear.

Sunburns

Pregnant people are more sensitive to getting sunburns because of the vascular changes that occur in pregnancy, including proliferation and dilation of the surface blood vessels, which is mostly driven by estrogen. Sunburns occur more quickly and frequently in pregnancy and puts you at risk for dehydration.

Dilation of the blood vessels can occur if you spend enough time in the sun to get sunburned, which is a problem due to the risk of dehydration. Pregnant people can be sensitive to dehydration because they depend upon that increasing circulating blood volume to produce the placenta and the baby.

Rashes

Some rashes can form that are unique to pregnancy. While most rashes are not a problem and will resolve, some can be concerning or indicative of a virus. Any time you get a rash during pregnancy, check in with your provider.

“When you notice a rash that persists for more than a day or is accompanied by a fever or other systemic symptoms, it is important to schedule a visit with your obstetrical provider. While many rashes in pregnancy are nothing to worry about, there are others that can be high-risk to both moms and babies. Your obstetrical provider is well versed in distinguishing rashes that maybe associated with real risk of harm in pregnant folks or their developing baby, or if it’s just a benign rash that doesn’t cause harm,” Aagaard said.

Skin tone

Regardless of your skin tone, sensitivity to sun remains high. Melasma and rosacea can be more prominent in people with darker skin tones. Aagaard emphasizes that no one – pregnant or not – is exempt from sunscreen and sun protection recommendations.

Hair and nails

Hair and nails can change during pregnancy, and some people might experience more hair and nail growth while others have less. Some might grow more facial hair, which is often accompanied by acne and tends to resolve in the second or third trimester.

Retinoic acid and vitamin A

Retinoic acid products, often used for treating acne, should be avoided during pregnancy. Retinoic acid and vitamin A are important for pregnancy, and using these products can inhibit that. The retinoic acid receptor is fundamentally important for normal development, so using these products causes a spectrum of congenital anomalies that can include pregnancy loss.

By Homa Shalchi