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Maternal adaptations to pregnancy: Skin, hair, nails, and mucous membranes

Miriam Keltz Pomeranz, MD
Section Editors
Charles J Lockwood, MD, MHCM
Robert P Dellavalle, MD, PhD, MSPH
Deputy Editor
Kristen Eckler, MD, FACOG


The maternal skin and related structures, including hair, nails, and mucosa, undergo numerous changes during pregnancy and the puerperium. The normal physiological alterations in skin during pregnancy are reviewed here (table 1). Pathologic cutaneous changes and their management are discussed elsewhere. (See "Dermatoses of pregnancy".)


The overall clinical appearance of skin is related to pigmentation, glands, vasculature, and connective tissue. Cutaneous changes during pregnancy can be best understood by examining each of these different aspects of skin structure.

Pigmentation — Almost all pregnant women develop some degree of increased skin pigmentation. This usually occurs in discrete, localized areas and may be due to regional differences in melanocyte density within the epidermis [1]. Occasionally, generalized hyperpigmentation occurs [2-4]. However, pregnancy is a rare cause of generalized hyperpigmentation, so other causes, such as Addison's disease, should be considered when it occurs.

The pathogenesis of the increased pigmentation is not completely understood. One possibility is that estrogens and progesterone cause melanocytic stimulation [5-7]. However, it has been shown that the pigmentary changes occur early in pregnancy and before the elevation in alpha-melanocyte stimulating hormone (MSH) plasma levels, which occur in late gestation [8].

The most frequent cutaneous pigmentary change is a darkening of the linea alba, which becomes the linea nigra [9]. The increased pigmentation may span from the pubic symphysis to the xiphoid process, but usually reverts to its normal hypopigmented state postpartum.

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Literature review current through: Nov 2017. | This topic last updated: Aug 07, 2017.
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