Pruritic Urticarial Papules and Plaques of Pregnancy and Its Relationship to Maternal-Fetal Weight Gain and Twin Pregnancy

Abstract

Thirty women who were seen at our institution between 1984 and 1988 for pruritic urticarial papules and plaques of pregnancy (PUPPP) were retrospectively evaluated and interviewed. We found a significantly increased maternal weight gain and newborn birth weight in patients with PUPPP, compared with age and parity-matched controls. The average weight gain during pregnancy was 18.1 +/- 0.9 (SEM) kg for the patients with PUPPP (excluding twin gestations) and 14.6 +/- 1.0 kg for the controls. The mean newborn birth weight was 3.6 +/- 0.09 kg for the PUPPP group and 3.3 +/- 0.08 kg for the control group. There were three twin pregnancies (10%), compared with the twin gestation rate at our institution of 1.6%. Therefore, based on our findings of an increased maternal weight gain and neonatal birth weight, an increased twin rate, and an abdominal eruption that occurs in primigravidas in their third trimester of pregnancy, we suggest that abdominal distention or a reaction to it may play a role in the development of PUPPP.

The specific dermatoses of pregnancy revisited and reclassified: Results of a retrospective two-center study on 505 pregnant patients

“…The second most common dermatosis observed in our patients' series, PEP (21.6%), occurred particularly frequently in primigravidae (73%) and multiple gestation pregnancies (16%), as previously reported. 11,12,[24][25][26] PEP started in late pregnancy (83%) or the immediate postpartum period (15%), with conspicuous abdominal involvement, seen in 98% of cases, characteristically affecting the striae distensae and sparing the periumbilical region. In contrast, PG, the only other dermatosis with marked abdominal involvement (95%), favored the periumbilical region in 72%.…”

A case-control study of polymorphic eruption of pregnancy

“…The time of PEP onset was analogous to previous studies by Roger et al, 3 Aronson et al, 5 Vaughan Jones et al, 6 Holmes, 8 and Rudolph et al 9 As previously described, PEP predominantly affects primiparous women (57.5%) in the third trimester of pregnancy (75%). [1][2][3][4][5][6] The association of PEP with male fetal sex has already been described but these studies locked matched-control subjects. 6,10 The significance of such male preponderance remains unexplained.…”

“…They found a significantly higher incidence of PEP with increased maternal weight gain and newborn birth weight, and an increased twin rate. 4 Some authors had proposed that mechanical distention of the skin could be implicated in its pathogenesis because women presenting with PEP were more frequently primiparae with increased maternal and fetal weight gain when compared with control subjects. 4 However, this result was not confirmed.…”

“…The eruption is most frequently seen in primigravidas and usually presents on the abdomen, frequently within the striae distensae. [1][2][3][4][5][6] Cutaneous lesions are mainly urticarial but vesicular or target lesions may also be seen. The PEP incidence is 0.4% to 0.8% of pregnant women.…”

Urticarial lesions: If not urticaria, what else? The differential diagnosis of urticaria

“…58 In contrast to gestational pemphigoid, it is not associated with fetal or maternal morbidity and mortality, but some studies have reported increased maternal weight gain and increased newborn birth weight. 57,59 There are no specific laboratory abnormalities; on histologic sections, a nonspecific perivascular lymphohistiocytic infiltrate with some edema and eosinophils in the dermis are observed. Direct and indirect immunofluorescence are routinely negative, a finding helpful in differentiating this entity from gestational pemphigoid.…”