Megan MacInnes, CNM

Now that winter is over, it's time to get outside and play! This month we offer information about your skin in pregnancy, and advice to help you enjoy the outdoors safely.

You may notice skin pigmentation changes as your pregnancy progresses. The area around your nipples (the areola) and your vulva (vaginal lips) becomes darker. A dark line may appear from your umbilicus (belly button) down to your pubic area; it sometimes extends upward to your breastbone as well, and is called the linea nigra. The most noticeable skin coloration change is a mask-like darkening of the face, known as chloasma. It occurs in over half of pregnant women. Sun exposure increases the depth of color in susceptible individuals, and later, taking birth control pills may cause a similar reaction.

Freckles and moles ("pigmented nevi") may also darken during pregnancy. If you have many moles, it's always a good idea to examine your skin regularly to look for changes in shape, size, color, or elevation above the skin surface. Any of these changes, or bleeding from a mole, should be brought to the attention of your midwife or primary care provider immediately. Have someone else examine your back or other areas you can't see easily.

The degree of skin coloration change tends to be related to the skin type of the individual, with light complected individuals developing less intense pigmentation. Most of the time, the coloration will fade and gradually return to normal after birth. The depth of color change appears to be related to the increased production of estrogen and perhaps increased levels of progesterone or melanocyte-stimulating hormone.

Using sunscreen is advisable for everyone to prevent burning, which increases the risk of skin cancer. For pregnant women, sunscreen will help prevent further darkening of the skin. Sunshine is a natural source of vitamin D, which increases calcium absorption, and calcium helps build your baby's bones and teeth. Within reason and with sunscreen, some amount of sun exposure can be beneficial. Again, your skin type should be your guide. If you burn easily, wear higher SPF sunscreen and limit exposure.

Spring brings back insects as well as sun. If ticks are a problem in your area, you can help prevent bites if you wear socks, long-sleeved shirts and long pants in grassy areas. To ward off those gigantic New England mosquitoes, use insect repellent with the lowest effective DEET concentration of around 10%. Two products that contain this percentage are "Skintastic" and "Skedaddle." Once you're back indoors, shower off. Since DEET is toxic in high doses and there is some absorption through the skin, it seems prudent to use a lower concentration of DEET and wash it off as soon as possible.

For many of us, spring is gardening season. Growing your own fruits and veggies can be very satisfying and easy to do. Whether you grow your own or buy them, watermelon and blueberries are great for constipation. Wear gloves while gardening, especially in areas where cats are out and about, to avoid contact with cat feces, a source of toxoplasmosis. Remember good body mechanics to save your back: bend at the knees, not at the waist; bring your work close to you; and get help with heavy lifting.

Going hiking? Keep a lookout for plants with green, shiny leaves in threes. Poison ivy is commonly found along New England roadways and paths. Have a bottle of "Tecnu" on hand. If you rub Tecnu all over exposed areas and shower off you may prevent a breakout.

If you have questions regarding the safety in pregnancy of these or other products that protect you from warm weather woes, a great resource is the Pregnancy Exposure Infoline at 1-800-322-5014. Happy Spring and Summer!

Disclaimer: The above represents the author’s opinion and is intended for the use of clients of the Midwives at Mount Auburn. It should not substitute for the advice of your own care provider.