Pregnancy stretch marks cause psychological, emotional burden
Click Here to Manage Email Alerts
Stretch marks can negatively impact pregnancy, quality of life and the psychological and emotional well-being of those who experience them, according to researchers at Michigan Medicine.
“Almost 15 years ago, we began to study stretch marks at the molecular level in the laboratory. We have found numerous alterations in collagen and elastic fibers, which normally provide strength, support and elasticity to the skin,” author Frank Wang, MD, William B. Taylor Endowed Professor of Clinical Dermatology at Michigan Medicine, told Healio.
Wang and colleagues are focused on the formation of the very earliest stretch marks, or striae gravidarum (SG), and he said that numerous pregnant volunteers have allowed them to take skin samples as soon as they form during pregnancy.
“One thing we heard consistently from many of these participants is that stretch marks were very bothersome to many of them, impacting various aspects of their lives. This prompted us to formally study the emotional and psychological impact of stretch marks, which has helped to validate the importance of the type of work we’re doing in the laboratory,” he said.
The researchers surveyed 116 pregnant patients with SG who were considering delivery at Von Voigtlander Women’s Hospital in Ann Arbor, Michigan.
The one-time, cross-sectional survey’s 35 questions were based on questions from the Dermatology Life Quality Index (DLQI) about the impact of skin diseases on embarrassment and self-consciousness, clothing choices, leisure activities and interpersonal problems, as well as on the authors’ own experiences with patients who had SG.
“We suspected that stretch marks caused distress and stigma to pregnant patients, so we created a survey that included questions about anxiety, depression, embarrassment and shame,” author Timothy Johnson, MD, Arthur F. Thurnau Professor of Obstetrics and Gynecology at Michigan Medicine, told Healio.
“Allergy and depression are issues for many of our patients, often exacerbated by stresses of pregnancy. We were not at all surprised that stretch marks were a stress that had not been well studied or recognized. We have numerous large studies looking at perinatal depression that have been done and are ongoing at our institution,” Johnson said.
According to the survey, 45% of the participants had a history of SG from previous pregnancies, 33% had SG from other causes and 65% had a family history of SG. The area most frequently affected by SG was the abdomen (n = 87; 75%), followed by the breasts (n = 50; 43%), hips (n = 50; 43%), thighs (n = 42; 36%), buttocks (n = 22; 19%) or other areas (n = 7; 6%).
In the survey, 75% (n = 87) of participants said they were most concerned about the lesions becoming permanent. Discoloration (n = 43; 37%) and discomfort such as itching or pain (n = 26; 22%) also were cited as concerns.
In terms of severity, 21% (n = 24) said their lesions were “very prominent,” 49% (n = 57) called them “moderate” and 30% (n = 35) said they were “barely visible.”
SG impacted embarrassment and self-consciousness the most, with 22% (n =26) saying they felt moderately embarrassed and 16% (n = 19) reporting “a lot” of embarrassment. Embarrassment and self-consciousness also had the strongest correlation with lesion severity (Spearman’s product-moment correlation coefficient [r] = 0.54; P < .0001).
Lesion severity also affected general quality of life (r = 0.43; P < .0001), choice of attire (r = 0.42; P < .0001), self-image and self-esteem (r = 0.42; P < .0001), feelings of anxiety and depression related to SG (r = 0.41; P < .0001), alteration of social and leisure activities (r = 0.31; P < .001) and creation of interpersonal problems (r = 0.22; P = .02).
“More than half of our participants reported trying something to prevent stretch marks, like creams or oils. This really indicated that stretch marks were bothersome to them,” Wang said.
SG affects a variety of life-quality facets in a correlated manner as well, Wang continued.
“In other words, an individual who was embarrassed about their stretch marks was also prone to experience other emotional/psychological consequences, such as feelings of anxiety/depression, and negative consequences on choice of attire and social activities,” he said.
Plus, many of these women reported that SG caused as much distress as other dermatologic conditions like acne or psoriasis that are known to have a negative impact on quality of life, Wang said.
Providers could therefore approach SG like other dermatologic concerns and ask patients whether their SG has caused emotional distress and if prevention or treatment strategies should be used, even if they aren’t completely effective or if they are potentially costly. Doctors could consider psychological support and adjustment strategies for these patients as well.
“They can provide empathy to pregnant patients, talk to them about the natural history of stretch marks and talk about how they will usually regress, which certainly happens for the violaceous (bright red) ones, which become less red and obvious after pregnancy,” Johnson said.
“Just recognizing stretch marks as a stress [and] depression and anxiety trigger for pregnant patients and talking about them and recognizing their negative effects can lessen their impact and the fears associated with them,” Johnson said.
The researchers are continuing their investigation into the molecular causes of SG to find targets for preventing new lesions and to better treat existing ones. They say they hope their scientifically based approach will lead to genuinely effective and less costly therapies.
Reference:
Karhade K, et al. Int J Womens Dermatol. 2021;doi:10.1016/j.ijwd.2021.10.015.