Why am I itching?

The skin on your abdomen (tummy) stretches as your baby grows, and it’s common for it to feel itchy.

About 2 in every 100 pregnant women feel itchy without seeing anything on their skin.

Sometimes itch can be a symptom of a pregnancy health condition, so it’s important to tell your doctor or midwife if you feel itchy.

If your vaginal area feels itchy, this could be a sign of an infection like thrush. If the area around your anus (back passage) feels itchy, this could be a sign of haemorrhoids. These are both common in pregnancy.

Pregnancy conditions that cause itch include:

• intrahepatic cholestasis of pregnancy
• polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy (PUPPP)

How can I relieve itch?

Here are some things you can try, which may help relieve itch:

• use moisturiser (before using any creams, check with your pharmacist if they are safe in pregnancy)
• have a cool shower and avoid getting too hot
• wear loose clothing
• use a non-soap body wash and don’t shower more than once a day
• avoid things which can worsen itch, such as rough fabrics, caffeine and alcohol

You can try an antihistamine such as cetirizine. Ask your pharmacist which antihistamines are safe to use in pregnancy.

What is intrahepatic cholestasis of pregnancy?

Intrahepatic cholestasis of pregnancy is a liver condition that causes itch without a rash. It’s rare and usually starts in the third trimester. It’s not known what causes it.

In cholestasis, your liver is less able to get rid of substances from your body, so bile acids build up and this makes you itchy. The itch usually starts on your palms and the soles of your feet and may spread to your chest, abdomen, back, arms and legs. It can get worse throughout pregnancy, and it goes away soon after your baby is born.

Some people with cholestasis also have jaundice (yellow skin), tiredness, nausea, abdominal pain and trouble sleeping.

Can cholestasis affect my baby?

Cholestasis can be dangerous for your baby. It can increase the risk of fetal distress, preterm labour and stillbirth. If you have cholestasis, your baby is more likely to need to be admitted to the neonatal intensive care unit (NICU). The higher your bile acid levels are, the higher these risks are.

How is cholestasis treated?

If you are diagnosed with cholestasis, you will need close monitoring by your doctor and have blood tests every week or 2 for the rest of your pregnancy.

You can try the soothing measures listed above to relieve itching. You might also get some relief by adding bicarbonate of soda to your bath, or by using a moisturiser containing menthol. Speak to your doctor or pharmacist to find out if these are suitable for you. Antihistamines can also help, so ask your pharmacist for advice.

Your doctor may prescribe a medicine called ursodeoxycholic acid (UDCA) which can lower your bile acid levels and reduce itch. UDCA may also reduce the risk of your baby being born early.

You may need to give birth earlier than expected if your bile acid levels are high.

What is PEP/PUPPP?

Polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy is an itchy, red, bumpy rash that often starts on your abdomen. It affects 1 in 160 pregnancies and usually starts late in the third trimester of your first pregnancy. It usually goes away within a few weeks after your baby is born.

PEP/PUPPP starts with small spots, called papules, which join to form larger red areas called plaques. It can spread to your buttocks, legs and arms. Most of the time it’s extremely itchy and can disturb your sleep.

The cause of PEP/PUPPP is not known, but it may be connected to skin stretching during pregnancy. It’s more common in a multiple pregnancy, if your baby is bigger or if you gain a lot of weight during pregnancy.

Can PEP/PUPPP affect my baby?

PEP/PUPPP is not harmful to your baby. There’s a very small chance that your baby could be born with a mild PUPPP rash but it will fade quickly.

How is PEP/PUPPP treated?

See your doctor if you have an itchy rash. They can usually tell if it’s PUPPP from your symptoms and how it looks. They can also check for other conditions that can cause a rash.

There’s no treatment to get rid of PEP/PUPPP, but you can reduce the symptoms.

Try the soothing measures listed above to relieve itch. Antihistamines may also help; ask your pharmacist for advice.

If you’re still itchy, you may need a steroid cream or a short course of steroid tablets. Check your options with a dermatologist or your obstetrician.

What else causes itch?

Atopic eruption of pregnancy

This refers to a range of itchy rashes during pregnancy. It’s common and can be related to atopic (allergic) conditions like eczema, asthma and hay fever. It usually causes dry skin. The rash can look similar to eczema, with rough red patches on your face and neck and in skin creases. The rash might also be bumpy and spread over larger areas. It's not harmful to your baby and usually improves with simple measures and steroid creams. It usually gets better after your baby is born, but you may have a tendency to develop atopic conditions.

Pemphigoid gestationis

This is a rare condition, with red bumps turning into itchy blisters that often need steroid tablets. It increases your risk of preterm labour and your baby being small. There's a chance your baby could be born with blisters, which will eventually go away.

Resources and support

If you have any questions or concerns about itching during pregnancy, speak to your doctor or obstetrician.