Stretch marks are common during pregnancy. This is a disfiguring gestational change affecting nearly 55-90% of women.1 Genetic factors, hormonal factors, and enhanced mechanic stress on the connective tissue, all play a role in the etiopathogenesis of striae gravidarum (SG). There has been evidence of twice as many estrogen receptors and elevated androgen and glucocorticoid receptors in striae as compared with those in healthy skin.1

There are several risk factors that may be associated with the development of SG. A cross-sectional study of 112 primiparous women assessed the participants during the immediate postpartum period for evidence of SG. About 60% of the study participants had developed SG. Women with evidence of SG were significantly younger (26.5 ± 4.5 vs 30.5 ± 4.6) and had gained significantly more weight during pregnancy (15.6 ± 3.9 vs 38.4 kg ± 2.7). Birthweight (BW), gestational age at delivery, and family history of SG were associated with moderate/severe SG.2 Another study suggested that a history of breast or thigh striae and race also predict SG development. It was noted that 81% of women with SG versus 30.5% without SG reported a history of breast or thigh striae and 47% of women with SG versus 17% without SG were non-white.3

Unemployment and lower education level have also been found to be associated with SG. Additionally, increased alcohol intake, decreased water consumption, decreased blood vitamin C levels, and expecting a male baby have also been found to be more common among women who developed SG in some studies.1

Several creams, particularly those containing medicinal herbs have been shown to prevent or reduce the severity of SG.1 A study assessed the effect of applying bitter almond oil and massage on preventing SG.

The frequency of striae gravidarum was 20% among women who applied bitter almond oil with massage, 38.8% among those who applied almond oil without massage and 41.2% in the control group. It was found that a 15-minute massage with almond oil during pregnancy could reduce the development of SG.4

Exercise during pregnancy could diminish the formation of SG by controlling weight gain. Exercises suitable for pregnant women can assist with increasing abdominal muscle strength, which may reduce the stress and strain on the abdominal skin. While some women are genetically predisposed to develop SG, athletes and women habituated to heavy physical work get very few or no stretch marks.5 Additionally, educating women preconceptionally on the importance of modifiable risk factors, such as body weight and maternal age before pregnancy could also prove to be helpful.5 Aloe vera and sweet almond oil creams have also been found to reduce the itching of striae and prevent their progression.6

Therefore, it is possible to prevent SG by means of appropriate and timely education of women regarding the modifiable risk factors, topical applications containing medicinal herbs, and appropriate exercises that may limit weight gain during pregnancy.

References

1. Farahnik B, Park K, Kroumpouzos G, Murase J. Striae gravidarum: Risk factors, prevention, and management. Int J Womens Dermatol. 2017 Jun; 3(2): 77–85.
2. Osman H, Rubeiz N, Tamim H, Nassar AH. Risk factors for the development of striae gravidarum. American Journal of Obstetrics and Gynecology 2007;196(1):62.e1-62.e5.
3. Chang ALS, Agredano YZ, Kimball AB. Risk factors associated with striae gravidarum. Journal of the American Academy of Dermatology 2004;51(6):881-5.
4. Timur Taşhan S, Kafkasli A. The effect of bitter almond oil and massaging on striae gravidarum in primiparaous women. J Clin Nurs. 2012 Jun;21(11-12):1570-6.
5. Ersoy E, Ersoy AO, Celik EY, et al. Is it possible to prevent striae gravidarum? Journal of the Chinese Medical Association 2016;79(5):272-275.
6. Hajhashemi M, Rafieian M, Rouhi Boroujeni HA, et al. The effect of Aloe vera gel and sweet almond oil on striae gravidarum in nulliparous women. J Matern Fetal Neonatal Med. 2018 Jul;31(13):1703-1708.