Stretch marks in pregnancy: what prevents them, what doesn't and what to do afterwards

It is one of the most common concerns in pregnancy, right after the baby's health: “Will I get stretch marks?”. Pharmacy shelves and social media are full of “anti-stretch-mark” creams and oils, and many pregnant women apply them religiously from the first weeks.

The truth is less encouraging than the marketing, but more liberating: most pregnancy stretch marks depend on factors that cannot be controlled, and no cream has convincingly been shown to prevent them. That does not mean there is nothing to be done. It means you can stop feeling guilty about them and focus your energy on what makes a difference: caring for your skin safely during pregnancy and treating early, after the birth, the stretch marks that bother you.

When they appear, how many pregnant women get them and why

Pregnancy stretch marks (in medical terms, striae gravidarum) are very common: studies point to roughly half to nine in ten pregnant women, depending on the population and how they are assessed. They appear mainly from the second trimester and often in the third, when the belly grows fastest. The most affected areas are:

• Belly, especially below the navel and at the flanks.
• Breasts.
• Hips and buttocks.
• Thighs.

In the early phase they are pink, red or purplish, may be slightly raised and itchy. In the months after the birth, they tend to lighten and become white or silvery.

Why they appear

Stretch marks are small scars of the dermis. In pregnancy, three factors come together:

• Rapid stretching of the skin, especially of the belly.
• Hormonal changes (oestrogens, relaxin, cortisol) that make connective tissue more fragile and less able to keep up with stretching.
• Genetic predisposition of the skin itself.

Who is at higher risk

Studies in first pregnancies (Atwal et al., 2006) identified the following associated factors:

• Family history (mother or sisters with stretch marks in pregnancy).
• Younger age. Interestingly, younger pregnant women have more stretch marks, probably because of the characteristics of the connective tissue.
• Greater weight gain during pregnancy and a higher body mass index before pregnancy.
• Bigger belly: large babies, twin pregnancy, excess amniotic fluid.
• Previous stretch marks, for example from adolescence.
• Lighter skin, according to some studies.

Most of these factors cannot be controlled. What can be influenced is weight gain, within what the doctor or maternal health nurse considers appropriate for you.

Prevention: what the evidence says

The Cochrane review

Cochrane, one of the leading organisations in the assessment of medical evidence, gathered the clinical trials on creams and oils to prevent stretch marks in pregnancy (Brennan et al., 2012). Six trials were included, with 800 women, testing olive oil, cocoa butter and combined creams (with vitamin E, hyaluronic acid, Centella asiatica extract or other ingredients).

The conclusion: there is no quality evidence that any of these products prevents stretch marks or reduces their severity, compared with placebo, no treatment or other creams.

A few useful details:

• Cocoa butter: in a randomised trial with more than 300 pregnant women, it showed no difference compared with a placebo cream (Osman et al., 2008).
• Olive oil: also showed no benefit in controlled trials (Soltanipour et al., 2014).
• Creams with Centella asiatica or hyaluronic acid: some older or small studies suggested a benefit, but with limited methodological quality and, at times, industry funding.

So is it not worth using cream?

It is worth moisturising, but for the right reasons:

• Relief from itching and the pulling of skin that stretches.
• Comfort and wellbeing. The moment of caring for your belly can be pleasant and reassuring.
• More comfortable skin with better texture.

What is not worth doing is spending a lot of money on products promising prevention, or feeling guilty if stretch marks appear despite the cream. A simple, fragrance-free, well-tolerated moisturiser does what is essential.

Other measures

• Appropriate weight gain, monitored by the doctor or maternal health nurse.
• Balanced diet and hydration.
• Physical activity suited to pregnancy, with professional guidance.

None guarantees the absence of stretch marks, but all are good for pregnancy in general.

Safety: what to avoid in pregnancy and breastfeeding

The skin absorbs part of what is applied, and in pregnancy some ingredients should be avoided. Choose the stage to highlight the column that interests you.

If in doubt, take the product to your pregnancy check-up or ask the pharmacist. And be wary of essential oils at high concentrations, which can irritate the skin.

Itching: what is normal and what isn't

Some itching of the belly is common in pregnancy, especially when the skin stretches and is dry. Moisturising, wearing cotton clothing, avoiding very hot baths and not scratching hard usually help.

But there are types of itching that deserve attention:

Cholestasis of pregnancy has its own guideline (Girling et al., 2022) and the pregnancy-specific dermatoses are described in Ambros-Rudolph et al., 2006. Do not use potent corticosteroid creams or antihistamines without medical advice during pregnancy.

After the birth: when and what to treat

Give it time, but not too much

In the months after giving birth, stretch marks gradually lose their red or purplish colour and become lighter and less visible. Many women are satisfied with this natural evolution. For those who want to treat them, there is one important point: stretch marks that are still red respond better to treatment than white ones, which are already mature scars (see Red and white stretch marks: why they appear and what works).

So, if stretch marks bother you, it is worth having an assessment in the first months after giving birth, even if some treatments have to wait until the end of breastfeeding.

During breastfeeding

• Moisturising and simple skincare.
• Some treatments in the clinic may be considered case by case.
• Topical retinoids generally postponed or only on medical advice and away from the breasts.

After breastfeeding

• Topical tretinoin, on medical prescription, in stretch marks that are still recent (Kang et al., 1996).
• Treatments in the clinic: vascular technologies for red stretch marks; fractional laser, microneedling and radiofrequency to improve texture and width; generally in series.
• Strength and core training, which improve the contour of the belly. Before intense abdominal exercises, check for abdominal diastasis with your doctor or a specialist physiotherapist.

Expectations

No treatment completely eliminates stretch marks. The aim is to make them less visible. And it is worth saying: stretch marks are a common mark of pregnancy, shared by most mothers. Whether or not to treat them is a personal choice, with no right or wrong.

At Luxmed, we support women in the postpartum period with an assessment of stretch marks, skin and abdominal laxity. We define what can be done during breastfeeding and what is better left until afterwards, always safely.

This article is for information purposes and does not replace pregnancy surveillance or a consultation. Before using any product in pregnancy or breastfeeding, check with your doctor.

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