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When you’re pregnant, your skin changes. Sometimes it’s more than just having a healthy glow about you. You might not be so happy about things like stretch marks, dark spots, acne, rashes. Are these changes normal? Are they permanent?

Jade Elliott say down with Dylan Alston, a dermatologist with Intermountain Healthcare on this episode of the Baby Your Baby podcast to talk about why your skin changes during pregnancy and what’s normal and what you might want to ask your doctor about and when to see a dermatologist.

The causes of skin changes during pregnancy

Some skin changes are due to changes in hormone levels that occur during pregnancy. There’s a shift in the predominant hormones, progesterone during pregnancy. For most skin changes, however, health care professionals are not sure of the exact cause.

Good changes to your skin during pregnancy

That healthy glow, may not be physiologic, but it could be due to increased blood volume during pregnancy. Increased circulation can make skin look healthier and brighter. Hormones can make oil production more prominent and skin can shine or glimmer. Plus, some skin conditions, like rosacea, acne, or eczema can clear up during pregnancy.

Normal skin changes during pregnancy

There are many changes that occur in the skin during pregnancy. Most are considered normal and do not affect the health of the mother or the baby.

Dark spots or hyperpigmentation

The most common skin change is hyperpigmentation, or a darkening of the skin in certain areas. Dark spots and patches are caused by an increase in the body’s melanin—a natural substance that gives color to the skin and hair.

After childbirth, dark patches of skin typically return to their normal pigment after a period of months. However, some dark patches may never fade.

This can involve the face causing chloasma or melasma, also known as the “mask of pregnancy.” This can be very distressing to women as it can cause significant discoloration and it is most common on the face. It can remain throughout life. If you develop dark spots, or sun spots, be sure to protect yourself from sun, which can prevent it from worsening. Your skin is also sensitive to any visible light – indoor light, cell phone or computer screen light, TV lights, etc.

What can be done about melasma?

Use a sunblock with a high SPF and that contains ferric (iron) oxide which protects skin from visible light.

Other types of hyperpigmentation

Linea nigra is a hyperpigmented line that appears on the abdomen from the pubic bone all the way up to the navel or even the breast bone. It’s unsightly but tends to fade after birth.

Darkening of the armpits can also appear.

Moles can darken or change. Hormones are to blame. Know the ABCDs of skin cancer and see a dermatologist if you notice one of the types of changes.

Changes to hair and fingernails

Women can experience changes in their hair and nails. About three months after delivery, the hair can begin to fall out in large amounts. This is normal stress-related hair loss. The stress of delivery has shocked the hair into falling out and it is transitioning in to a new hair growth phase.

Acne

Many women have acne during pregnancy. Some already have acne and notice that it gets worse or better during pregnancy. Other women who have always had clear skin may develop acne while they are pregnant.

Tips to treat acne:

• Wash your face twice a day with a mild cleanser and lukewarm water.

• If you have oily hair, shampoo every day and try to keep your hair off your face.

• Avoid picking or squeezing acne sores to lessen possible scarring.

• Choose oil-free cosmetics.

• Prescription therapy may be needed and see your doctor or consult with a dermatologist to see what is safe. Many topical acne treatments are safe during pregnancy.

Pregnant women should not take the oral acne medication Accutane or the generic isotretinoin or the generic equivalent as it can cause severe fetal defects. Topical versions with Retin A should also not be used during pregnancy. Before or after pregnancy, birth control pills can cause acne.

Stretch marks

Stretch marks are indented streaks that often appear on the abdomen, breasts, hips, buttocks and thighs. They’re caused by the stretching of the skin and are common during the second and third trimesters. Stretch marks are more likely to happen with rapid weight gain, with twin pregnancies or in women who are already obese.

Typically, they’re just unsightly scars. Using a heavy moisturizer may help keep your skin soft, and aggressive moisturizing of the abdomen can help offset the risk of stretch marks. Coconut oil or bio oil can help, but it will not help get rid of stretch marks. Most stretch marks fade after the baby is born, but they may never disappear completely.

If you develop a rash near the stretch marks, you may want to see a dermatologist. It’s called PUPPP (pruritic urticarial papules and plaques of pregnancy). It’s a rash that starts in the stria or stretch marks in the third trimester and is more common in twin pregnancies. It is horrifically itchy. It can be so intrusive that an early delivery may be recommended.

When to see a dermatologist about a skin condition when you’re pregnant

When you are pregnant, there are really two patients: mom and baby. The needs of the baby may be more pertinent. Some skin changes are considered pathologic or abnormal and could affect the health of the mom or baby. Some rashes can affect the health of the mother and even more concerning, some rashes can impact the health of the baby. It is important to be seen by a board-certified dermatologist if you have one of these conditions:

• Blistering around the belly button – This can impact morbidity or mortality of baby.
• A rash with a large oval or circular patch on the chest, back or torso – Pityriasis Rosea. Usually, this starts as one large patch and then after 3-7 days, smaller versions develop in a Christmas tree pattern. It may be related to a viral infection. It is usually asymptomatic.
• Severe itching of the palms of the hand or soles of the feet can be due to cholestasis of pregnancy – a liver condition where bile acids in the liver are getting obstructed. It causes severe itching on palms of hands or soles of feet and can spread to the trunk. It occurs in the third trimester, but goes away after childbirth. It can lead to preterm birth, or other problems.

For more information, click here.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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As schools are closed and social distancing continues during the coronavirus pandemic, more kids than usual are playing outside their homes, often at unexpected times of day. That’s why it’s more important than ever to keep kids safe. This means using Spot the Tot safety techniques to help prevent accidental back-overs or front-overs, and making sure that you and your bike-, scooter- and skateboard-riding crew wears a helmet every ride, every time.

Jade Elliott spoke with Jessica Strong, community health manager, Primary Children’s Hospital, to discuss the Spot the Tot program and helmet safety.

Spot the Tot

Use the Spot the Tot safety techniques can help prevent accidental back-overs or front-overs.

Between 1991 and 2018, 1,427 children nationwide died from injuries sustained in a backover, meaning the child was accidentally rolled over by a moving vehicle. In Utah, 62 children have died in backovers since 1991. That’s the fifth highest number of such fatalities in the nation.

Most often, fatalities occur when a child is accidentally run over by a vehicle in a driveway or parking lot, most often driven by a parent or caregiver.

These accidents can be prevented, starting with a 10-second walk around your vehicle. While backup cameras can help with visibility, they also have significant blind spots at each corner. The best prevention is human intervention.

You can Spot the Tot and Prevent injury by doing these three things:

o Walk completely around the car before getting in to drive

o Eliminate distractions (put phone away, turn off music)

o Roll down windows and listen before backing up

Here are some other tips to help keep kids safe:

o Supervise children when others are getting into a car.

o Teach children not to play in or around cars.

Wear a helmet – every ride, every time

Each year, more than 1,200 people die and thousands more are seriously injured in bicycle, roller blade, scooter and skateboard accidents. The most serious accidents involve head injuries. Many of these can be prevented by wearing a safety helmet.

Help your child get into the habit of wearing a helmet on every ride they take, whether on a bike, scooter, or skateboard. Make sure the helmet fits properly, and remember that kids outgrow helmets, just like they outgrow clothes or shoes.

Use this checklist to ensure your child’s helmet fits properly before they ride:

• Be sure your helmet has an CPSC or SNELL label certifying it is safe.

• Don’t wear a hat or anything else under the helmet

• The helmet should fit snugly and sit level on your child’s head.

• The helmet should fit two finger widths above your child’s eyebrow

• For the side strap: Make a V shape under your child’s ears with the strap and clasps.

• Under the chin: You should be able to fit one adult’s finger between the child’s chin and the strap.

Other Tips:

• Make sure you are using equipment as designed, only one person per bike.

• Don’t tie or drag other people behind you. They don’t have brakes and can’t stop like the bike rider.

• Obey all traffic laws like stop signs and lights.

• When riding in a group, always ride single file on the street.

• Never wear headphones while biking.

For more information, visit primarychildrens.org/safety.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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Being pregnant for the first time or being a first-time mom means a woman will be making a lot of changes. You now have another person’s needs to care for and think about, besides managing your own personal needs.

Plus, when you’re pregnant and after you deliver your baby, your hormone levels are changing. On top of that, many new mothers are unable to get the rest they need to fully recover from giving birth. Constant sleep deprivation can lead to physical discomfort and exhaustion.

For all of these reasons, pregnancy and the postpartum period are a time when women are susceptible to mood disorders like depression and anxiety.

Add to that, the COVID-19 global pandemic, which may increase anxiety and social isolation, and also lead to life stressors like a job change or moving, and that’s a lot of things that can factor into a woman’s mental health. Many women may wonder if their feelings are normal, or if they are just the baby blues, or if they may be experiencing true depression or anxiety.

Jade Elliott talked with Kristy Jones, from Intermountain Healthcare who is a senior consultant for mental well-being and community health, about the behavioral health resources available for pregnant and new moms who are going through all these changes amid the COVID-19 pandemic.

Postpatum depression is common

Up to 1 in 7 women experience postpartum depression.

Risk factors for PPD:

• Previous mental illness or family history of such
• A stressful life event during pregnancy or soon after birth (job change, moving, divorce, death of a loved one)
• Traumatic labor and delivery or medical complications of mother or baby
• Mixed feelings about the pregnancy
•  Isolation or lack of emotional support from family or friends
• Alcohol or drug abuse problems

If you have some of these risk factors and are experiencing some mental health symptoms you’re concerned about you can always reach out to your doctor with your concerns. Another great option is the Intermountain Emotional Support Hotline.

The Emotional Health Relief Hotline

•  It is a free service provided by Intermountain Healthcare to help people in emotional distress and is available from 10 am – 10 pm 7 Days per week
• Number 833-442-2211
• People responding to the calls – a great mix of Intermountain Caregivers differing skills such as our Behavioral Health Patient Navigators and COVID Call Center Staff.

1.  All have been trained
2. No DX work

 What happens when someone calls in?

• The caller will be asked predetermined questions that will help to assess their level of needs. Each caller will be triaged as Low, Medium or High need.
•  If there is a high concern or suicidal concern, there is a “warm” handoff to the U of U University Neuropsychiatric Institute (UNI). This is the same Crisis Line that operates the Utah chapter of the National Suicide Lifeline.
• Based on the level of need, they may be provided some resource materials, referred to the myStrength App (free for 60 days with code UDHSGuest33), provided resources to connect them to service – or given a warm handoff to a crisis hotline
• If someone calls the Relief Hotline after hours – it refers those with a high concern to the UNI Crisis line which operates 24 hours a day.

What are some general tips we can provide for being mentally well?

• stay connected with friends and family through video chats, phone calls and “drive-by” visits
• Physical activity and exercise can help boost your mood
•  Reduce Stress and anxiety – ie limit exposure to constant messaging relating to the pandemic, use focused meditation and relaxation, set and keep a schedule or goals for the day
•  Ask for help when needed – call the Emotional Health Relief Hotline, reach out to a friend or family member, see your provider via telehealth / video visit.

  The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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If you’re pregnant during the COVID-19 pandemic, you may have questions about your prenatal clinic visits and staying healthy.

To help you and other patients stay safe during the COVID-19 pandemic, Intermountain Healthcare has modified some of the OB prenatal appointments to include video visits in addition to your in-person visits if you have an uncomplicated pregnancy. This visit schedule is based on national recommendations.

Jade Elliott spoke with Angela Anderson, certified nurse midwife with Intermountain Healthcare, who explains how these virtual visits work.

Some telehealth prenatal visits are available for low-risk moms without pregnancy complications

This program has been in place for over a year at the Nurse Midwife clinic at Intermountain Medical Center and provides a safe and convenient platform for remote prenatal visits at specific intervals during an uncomplicated delivery using Connect Care, Intermountain’s Telehealth platform, which is now expanding to other locations along with Intermountain Medical Group providers. Ask your provider about your eligibility for video visits for a number of your prenatal visits.

Some in-person visits are still necessary

In general, in-person visits are still recommended for your initial visit; your 20-week ultrasound; labs done at 28 weeks; and appointments after 36 weeks. During the in-person visits, they will perform a physical exam, obtain necessary labs and measurements, etc. Check with your provider to find out what is recommended for your specific situation.

Telehealth visits are an excellent option during the COVID-19 pandemic as you can interact with your provider through video. Phone appointments are also available if you prefer. Check with your provider about what they offer.

Video visits are a safe alternative for uncomplicated pregnancies and have been studied at shown to be successful at other institutions in the U.S.

Technology needed for home visit:

• iPad or computer
• Download the Intermountain Connect Care app.
• Platforms include Connect Care where available, Google Duo, WebEx, Facetime, etc.

How the program got started

There’s been an interest in this for several years and Intermountain looked into some pilot programs at other institutions in the U.S. and they had good outcomes and high patient satisfaction. With our telehealth program well developed, the time was right.

Moms need to meet certain criteria to be able to do video visits

• No serious chronic medical conditions.
• Access to a computer, iPad, tablet, smart phone or other mobile device with internet access.

Five key face to face visits in clinic are needed

The schedule of face-to-face and virtual visits is up to the patient and should be flexible to meet a patient’s clinical and personal needs. Five key face-to-face visits are done during these time frames.

1. Initial prenatal visit with labs
2.  18-20 week ultrasound visit
3. 28 week laboratory/vaccination visit (diabetes screening, hematocrit, Tdap)
4. 36 week laboratory visit (GBS)
5. 38-40 weeks delivery planning / physical exam visit

The remaining virtual visits are scheduled according to the standard visit schedule to meet the needs of the individual patient.

Providers like the home prenatal visits too

At home visits offer more actual face time with the patient, allowing for more time to talk and increasing satisfaction for the provider as well. Because medical assistants are not involved, it frees them up to help office clinic schedules run more smoothly.

For more information about home prenatal visits go to intermountainhealthcare.org.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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Medical teams are still learning about COVID’s impact on children. While the majority of children have a relatively mild illness, children with complex health care needs sometimes have more symptoms. Some examples of conditions with more complex needs include asthma or other lung conditions requiring medication or ventilators, heart conditions, and diabetes.

That’s why pediatricians and specialists are implementing new, safe ways for families to access care for their children and update their individual health plans.

Jade Elliott spoke with Dr. Neal Davis, pediatrician, Intermountain Healthcare, about what parents should do if their child needs to visit the doctor.

Many medical practices for children are now able to perform video visits with patients with these type of medical conditions. These visits are a perfect time for parents to check in with their child’s medical provider and make sure they have a clear plan of care for their child.

This plan of care includes making sure parents and providers have a shared understanding of the care plan, including current medications and how to reduce risk of severe sickness, and a clear pathway for communication if the child starts to get sick and parents have concerns.

For more information, please contact your child’s medical office to learn about the specific practices they are using to provide needed services while reducing the risk of COVID-19 exposure.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.