Women Talk: Stretch marks: The bane of pregnancy

Kathleen, a 27-year-old hairdresser, came to see me during her 24th week of pregnancy (around 6 months). Two weeks ago she suddenly noticed long, broken dark lines forming on the skin of her abdomen. When she looked closely, there were the same lines on her lower back, upper thighs, and shoulders. She was distressed because they had become dark and very pronounced, especially because she was fair-skinned.

She had been looking forward to going back to the beach after her pregnancy, as they lived near the sea, and worried that she might look unattractive in a bikini. She also felt guilty because last month there were times when she had to scratch her abdomen and upper thighs because the skin in those areas felt so itchy. Was this the cause of the dark lines on her skin?

Elastic layer breakdown

Striae gravidarum, or stretch marks during pregnancy, usually occurs because of the breakdown of the elastic tissues of the dermis. This happens when the skin starts to become stretched to accommodate the growing baby. This also occurs when there is sudden weight gain, even if one is not pregnant. There are women, though, whose skin somehow remain smooth and elastic, with nary a stretch mark, even if they are mothers of three or more. And there are young women who easily develop stretch marks during their first pregnancies. Genetics of course, has something to do with it, with mothers and daughters sharing the same problems of dark lines on the abdomen after pregnancies. Some women are enviably smooth-skinned, because for some reason, the elastic layer of their dermis remains intact even with many pregnancies.

Studies moreover show that darker-skinned women are more prone to develop stretch marks, even if they have kept their weight gains to within the normal range.

Prevention

The best prevention is to eat right during pregnancies. Avoid too much and sudden weight gain (the normal weight gain in pregnancy is from 25 to 30 pounds in the nine-month period). Drink lots of liquids to keep yourself hydrated. Eat fresh foods and vegetables.

Contrary to popular myth, stretch marks do not come about because of scratching, although we have a Tagalog name for stretch marks, which is “kamot”—literally, “to scratch.” The term probably came about because the marks look like fingernail scratch marks: long, crooked, and often broken. I reassured Kathleen that it was not her scratching that brought about the stretch marks. Another myth that one patient brought up was that the stretch marks were caused by the baby’s fingernails. Her baby, it seemed, came out with long fingernails; and the mother had many stretch marks in her abdomen and thighs. I had difficulty reassuring her that the marks were not the baby’s fault!

Creams and lotions

How about lotions and potions that are out there in the market? Even when we were still in medical school there had been a lot of products in the market that were supposed to help prevent, or erase, stretch marks. Until now, the market is full of these products: from hormonal creams, retinoic acid (be careful in using these during pregnancy), vitamin A and E oils, Vaseline, baby oil and moisturizers to herbal concoctions like shea or cocoa butter cream, pure virgin coconut oil, cooking lard, and even ground coffee. Sadly, there is no strong medical evidence that these products can prevent or erase stretch marks.

One good news is that these marks, while looking so stark and pronounced during and right after pregnancy, will gradually fade into white, silvery lines, with time. If the woman also successfully loses weight and improves the tone of her abdomen and thighs, the lines will become less conspicuous.

Laser and surgery

In a few cases, some women can opt to have laser surgery to repair the elastic layer of the dermis, and hopefully regain the original smoothness of the skin. This is of course an expensive procedure, and one needs to be realistic about the results. Do talk this over with your dermatologist, if you feel that the stretch marks really bother you. Some women who need to bare their abdomens in their work (models, screen actresses) might opt for laser surgery.

Cosmetic surgeons can also do “tummy tuck” procedures and remove the skin that has these stretch marks. Certainly these are done for women who are very sure that no pregnancy will occur again; otherwise, the costly operation will all be for naught.

Attitude

Lately, many women had been coming out with their stand on post-pregnancy stretch marks. Some even post pictures of their abdomens, stretch marks and all, on social media sites. They proclaim that these, like battle scars, are something to be proud of, and not to be disguised or removed. Bold and confident, they tell the world that they are not bothered by these marks, their badges of being heroines. This is of course another angle that some women might want to think about.

Looking forward to baby

Kathleen was relieved to know all these things, and looked forward to her delivery date, to finally seeing her baby girl, after all these months of waiting. She has been very careful with her diet, and her weight gain had been within limits. Indeed, she had made peace with her stretch marks. — BM, GMA News

Dr. Alice M. Sun-Cua is an author and practicing obstetrician-gynecologist at the San Juan de Dios Hospital in Pasay City.