It is quite common to have dry and itchy skin in pregnancy . However, that does not mean that it is not extremely irritating to have to itch all over all the time. Moreover, severe itching while pregnant can even indicate serious complications involving the skin or liver .
Is itchy skin an early sign of pregnancy?
Itchy skin is not counted among the early pregnancy symptoms as it may occur at any stage in the first, second and third trimesters, depending on the underlying causes and your hormone levels. Moreover, only around 20% of all pregnant women experience the signs of itchy skin .
When does itching occur during pregnancy?
In most cases, itching starts during late first or early second trimester as your uterus begins to get bigger and your belly skin starts stretching while the hormone levels near their peak . Although it is also normal to have the symptom in the last trimester, itching in late pregnancy might signal underlying liver problems.
What causes itchy skin in pregnancy?
Like most other pregnancy pains and symptoms, the changing hormone levels are often to blame for making your skin dry and flaky, which leads to itchiness . Your skin stretching to accommodate the growing uterus is another common reason behind the problem .
Sometimes, dry skin and itching might be accompanied by rashes or red spots. These symptoms are often caused by pregnancy related skin conditions like pruritic urticarial papules and plaques (PUPPP)  or atopic and polymorphic eruptions . The exact causes of these conditions are still unknown, but some of them are more likely to occur when expecting twins or triplets . Pregnancy may also worsen the symptoms of skin diseases like dermatitis or eczema .
Super sensitivity to certain substances that never bothered you before pregnancy (e.g. chlorine in your swimming pool) may also be the reason behind the symptom .
Areas susceptible to itchiness while pregnant
Itchiness that occurs due to the skin stretching for accommodating the uterus usually affects the belly area, breasts, nipples, back, thigh and hips .
Other areas susceptible to dryness, flaking and itching because of the changing hormone levels include the legs, hands, feet , palms (palmar erythema) , neck and scalp .
How to get rid of itchy skin in pregnancy
Not all skin creams and lotions are safe for pregnant women. So, it is recommended to try and treat the symptom with the following tips and home remedies until it goes away on its own after delivery .
Tips to manage and relieve itchy skin
- Avoiding scratching the area as much as possible as it only worsens the problem 
- Avoiding hot baths and showers as they tend to dry your skin further 
- Drinking plenty of water to prevent your skin from getting dry 
- Applying a cold compress on the itchy area 
- Wearing loose-fitting breathable cotton clothes 
- Using pH balanced body washes and mild moisturizing soaps instead of your regular products 
- Avoiding exposing your skin to direct sunlight as much as possible
- Patting your skin dry after every wash to avoid additional irritation
- Avoiding strong perfumes and deodorants 
Home remedies to stop itchiness during pregnancy
- Taking a warm (not hot) oatmeal bath  (you can make your own oatmeal bath by grinding oats in a coffee grinder or you can buy oatmeal bath preparations from local drugstores) 
- Applying baking soda and water paste on the itchy areas might help (it is recommended to consult your midwife regarding the safety of using this natural remedy) 
- Dabbing some apple cider vinegar on the affected areas using a clean cotton ball
- Applying some aloe vera gel on the itchy area, leaving it on for a few minutes before rinsing off with water 
- Applying coconut oil over your body after taking a shower 
Creams and lotions for itchy skin relief
Using the following creams, lotions and moisturizing products can help to sooth the skin in relatively severe cases:
- Unscented petroleum jelly 
- Gentle unscented moisturizers (the scented ones are more likely to cause irritation) 
- Mild calamine lotion 
- Calendula cream
- Vitamin E oil or cream 
Your doctor may prescribe topical steroids or antihistamine creams  to reduce extreme itching caused by skin conditions like eczema. Medicated emollient creams may also be recommended by doctors to treat itchy skin at night . Your doctor may recommend taking Benadryl for soothing the itchiness at night, especially if it is resulting from an allergic reaction .
Itchy Skin during pregnancy and obstetric cholestasis
Obstetric cholestasis (OC) or intra-hepatic cholestasis of pregnancy (ICP) is a rare liver complication that affects around 1% of all pregnant women in US . It generally occurs during the third trimester, going away automatically after childbirth . Sometimes, the pregnancy hormones can slow down or stop the bile flow, leading to bile accumulation in the bloodstreams . The built-up bile then leads to persistent itching in different skin areas .
When to call the doctor?
Sometimes, the itchiness may result from serious skin or liver conditions that can be harmful for your unborn baby unless treated properly . Make sure to contact your doctor or midwife in the following cases:
- Itchiness that continues to get worse even after using the above treatments and remedies for about a week 
- Extremely itchy skin along with the symptoms of dark urine and pale stools (might indicate serious liver disorders like intra-hepatic cholestasis of pregnancy) 
- Severe itching on your palms and soles (might indicate a liver disorder)
- Itching that tends to get worse at night, but no rashes (might indicate obstetric cholestasis) 
- Developing reddish bumps, a new rash or hive-like symptom along with itching while pregnant (might indicate serious allergies or skin conditions) 
Itching ICD-9 and ICD-10 codes
The ICD-9 code used for indicating this symptom is 698  while its ICD-10 code is L29 .[ref]
- http://www.nhsdirect.wales.nhs.uk/doityourself/pregnancy/CommonProblems/ [/ref]