Pregnancy and Lactation

A dermatologist’s guide to stretch marks in pregnancy.

Up to 90% of first time mothers will have stretch marks. They usually first appear in the late second and early third trimester, however one study showed that 43% of women actually develop them before the 24 week mark.

Stretch marks also called striae are a common, disfiguring change that affects between 50 and 90% of pregnant women. Not only do they cause distress, but they also significantly reduce quality of life. Doctors often dismiss stretch marks as a “cosmetic” concern, but that doesn’t reduce the suffering you are experiencing. Here, we will discuss what causes stretch marks and some new evidence about potential ways to prevent and treat them.

What exactly are stretch marks?

Stretch marks first present as flat, pink to red marks that later become raised, longer, and darker. Over a period of several months to years, the marks will fade and become lighter, but in some cases they remain as wrinkled, scar-like patches. Stretch marks can sometimes cause itching, burning, and pain. They usually are found on the breasts, tummy, hips, and thighs. Up to 90% of first time mothers will have stretch marks. They usually first appear in the late second and early third trimester, however one study showed that 43% of women actually develop them before the 24 week mark.

Stretch marks are an unsightly and frustrating skin change of pregnancy.

What causes stretch marks?

The cause of stretch marks is a combination of genetic and hormonal factors as well as physical stretching of the skin associated with your growing baby. Interestingly, skin stretch is somewhat controversial and some studies have not shown a relationship between maternal weight gain and stretch marks. Stretch marks have twice as many estrogen receptors compared to normal skin, which respond to the big fluctuations in hormones during pregnancy.

Studies have shown that the biggest risk factor for stretch marks include younger age, having a mom who had stretch marks, higher pregnancy weight gain, and higher birth weight. Most studies also show that if a woman has a history of stretch marks before pregnancy, she will have more severe stretch marks during pregnancy. One study of 299 White women found that stretch marks on the breast increased the risk of pregnancy stretch marks, however stretch marks on the thighs actually decreased the risk. Stretch marks may be more common in women of color. Increased alcohol intake, decreased water consumption, lower vitamin C levels, and expecting a male baby are other potential risk factors for developing stretch marks.

So what can be done to treat and prevent them?  

Creams that contain Centella asiatica extract, a natural herb, are probably the most effective. A trial of a cream containing Centella asiatica extract with vitamin E and collagen applied daily from week 12 until delivery significantly reduced the appearance of stretch marks compared to placebo. This cream also reduces the severity of stretch marks that do develop. Almond oil, olive oil, and cocoa butter, despite being the most common things used, don’t have any science backing them. One study did show that when olive oil was massaged into skin daily there was a lower rate of stretch mark development. However, the results were probably related to the massage itself and not the oil.

What can you do to treat stretch marks that have already developed? A large trial showed that Retin-A (tretinoin) used on a daily basis for 3 to 6 months improved the appearance of stretch marks by 50% and decreased length and width by 20 and 23%, respectively. Retin-A increases collagen formation in the skin, which leads to better looking skin. However, it is NOT safe to use in pregnancy because it can cause birth defects. Fractional lasers like Fraxel can improve stretch marks by 50 to 75% after 2 to 6 treatments also by increasing collagen production. It is safe and well-tolerated both during pregnancy and afterwards. Carbon dioxide lasers are also effective but are more painful and have a longer recovery time. Finally, microdermabrasion and micro-needling have been found to be effective in multiple studies, particularly for red stretch marks.

Tretinoin (Retin-A) is a safe and effective way to treat stretch marks after giving birth.

Putting it all together

In conclusion, stretch marks are a common skin change of pregnancy and can be a big source of the stress during an already stressful part of your life. They are a totally normal part of pregnancy and most women develop them. Despite a better understanding of what causes them, prevention of stretch marks remains a challenge. However, there are a few things you can do to improve the appearance of stretch marks. Share your stretch marks stories and home remedies in the comment section below and please share this article with other women who may be interested.

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