Skin Disorders in Pregnancy

Many endocrinopathies demonstrate dermatological manifestations that facilitate previously undiagnosed endocrine disorders with maternal and fetal ramifications. Maternal and fetal risks depend significantly on early diagnosis and management of these endocrinopathies in order to prevent perinatal mortality and increased overall morbidity. A plethora of systemic and dermatological inflammatory conditions may develop in the course of pregnancy complicated with diabetes. Maternal obesity and gestational insulin resistance also provoke low-grade inflammation, which downregulates placental leptin gene expression and diminishes tumor necrosis factor alpha and interleukin-6 in the fetus, causing placental morphometry changes and higher fetus weight. Markers of microangiopathy such as impaired endothelial permeability and increased intima thickness are detected in higher levels in pregnant diabetic patients. Hence, pregnancy acts as a “stress test” to identify women with diabetic predisposition and susceptibility to chronic persistent inflammation. Dermatological disorders that evolve during pregnancy are classified in two main categories: specific conditions that occur more commonly or exacerbate during pregnancy and diabetes-related skin diseases. Their prompt verification insured by a highly qualified multidisciplinary team of an obstetrician, a dermatologist, and an expert endocrinologist helps to optimize management and improve outcomes. Diabetes prevention requires lifestyle changes and exercise promotion to prevent a healthier mother and child’s future. Insulin is the first choice of treatment in complicated cases. The role of other antihyperglycemic agents requires more sophisticated and larger randomized controlled studies to evaluate their efficacy and safety.