|Year : 2019 | Volume
| Issue : 2 | Page : 72-76
The effect of striae gravidarum on quality of life in a sample of Turkish pregnant woman population
Atiye Ogrum1, Hatice Yilmaz Dogru2
1 Department of Dermatology and Venereology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey
2 Department of Gynecology and Obstetrics, School of Medicine, Gaziosmanpasa University, Tokat, Turkey
|Date of Submission||18-Jun-2018|
|Date of Acceptance||17-Oct-2018|
|Date of Web Publication||28-May-2019|
Dr. Atiye Ogrum
Department of Dermatology and Venereology, School of Medicine, Gaziosmanpasa University, Tokat
Source of Support: None, Conflict of Interest: None
Background: Striae gravidarum is a commonly occurred physiological change among women with pregnancy. Although these changes are accepted as physiological, the lack of therapeutical and preventive techniques led to impaired quality of life of women. The aim of this study is to evaluate the effect of striae gravidarum on quality of life in a sample of Turkish pregnant woman population and the usage of cream/lotion to prevent the striae. Methods: Women with pregnancy whose completed 36 weeks of their pregnancy and admitted to the Obstetrics and Gynecology outpatient unit between March 2017 and August 2017 were included in the study. The severity of striae was assessed using Davey's score. The effects of striae on patient's quality of life were evaluated by Skindex-29 questionnaire. The usage of cream/lotion whether or not was also asked and recorded. Results: A total of 153 women with pregnancy were included in the study. Of those 43.1% (n = 66) was primiparae and 56.9% (n = 87) was multiparae. The prevalence of striae gravidarum in total, primiparae and multiparae was 75.8%, 66.7%, and 82.7%, respectively. There was a weak positive correlation found between the parity and severity of striae (ρ =0.190, P = 0.018). The emotion and symptom score of primiparae women with severe striae were higher than women without striae (P = 0.001; P = 0.028, respectively). The usage of cream/lotion was significantly higher in primiparae compared to multiparae (P < 0.001). The symptom and emotion scores of the women with striae those applied cream were higher than nonusers (P < 0.001; P = 0.038, respectively). Conclusions: Striae gravidarum may cause psychological and physical effects among women, especially primiparae women with severe striae and negatively affects the quality of life. Cream/lotion may be used to prevent striae development and reduce symptoms of pregnant women with higher emotion scores.
Keywords: Pregnancy, quality of life, skin manifestations, skindex-29, striae gravidarum
|How to cite this article:|
Ogrum A, Dogru HY. The effect of striae gravidarum on quality of life in a sample of Turkish pregnant woman population. Dermatol Sin 2019;37:72-6
| Introduction|| |
Striae gravidarum is the physiological change of the skin during pregnancy period., The prevalence due to the cultural variation is very diverse and estimated over 70% among the Turkish population., It is clinically characterized by pink-to-violet bands that become hypo-pigmented, white atrophic marks on the abdomen, breasts, and thighs. Although this kind of connective tissue changes are accepted as physiological, the lack of therapeutical and preventive techniques led to impaired quality of life of women.,,, Quality of life is culturally established, subjective and multidimensional wellbeing experience. Feeling confident, integration of social life and media are found in this experience. Any changes in an individual may affect this multidimensional long-term experience in various levels. Therefore, the effect of stria gravidarum on the quality of life can alter among different cultures.,,, There has been no study conducted on the effects of striae gravidarum on quality of life in a sample of the Turkish woman population. The hypothesis is that striae gravidarum may affect the quality of life which is directly related to the intensity of sriae. The aim of the present study is to evaluate the impact of striae gravidarum and its severity on quality of life and also demonstrate the usage of cream/lotion for preventing striae.
| Methods|| |
This cross-sectional designed study was performed between March 2017 and August 2017 at Gaziosmanpasa University Department of Obstetrics and Gynaecology after approval of the Clinical Research Ethics Committee (17-KAEK-016).
Participants and procedure
Women with 36 weeks of pregnancy who admitted to the outpatient unit for antenatal examination were asked to participate in the study and complete the Skindex-29 questionnaire. Gestational age, height, weight before pregnancy, body mass index (BMI) before pregnancy, weight gain during pregnancy, and the use of cream/lotion for preventing striae were questioned and recorded. The severity of striae gravidarum on the abdominal area was evaluated by a dermatologist whose blinded to the study using Davey's method. Briefly, the abdomen was divided into four quadrants. Each quadrant was assessed and scored from 0 to 2 (0 - clear skin; 1 - moderate number of striae; and 2 - many striae). The summation of the scores obtained from the quadrants was ranged between 0 and 8. The severity of striae was evaluated and categorized as 0 (absent), 1–2 (mild), and 3–8 (severe).
All participants were asked answer the question “Have you ever used cream or/and lotion to prevent stretch marks during this pregnancy?” whether they had or not applied cream/lotion to prevent striae gravidarum.
This questionnaire consists of three scales as emotion (10 items), symptom (seven items), and functioning (12 items). The emotion scale assessed the psychological aspects of the disease, such as anxiety, depression, fear, embarrassment and anger; symptom scale evaluated the physical effects of the disease, such as sensitivity, itching, irritation, and pain; functioning scale assessed the impacts on daily life, such as social isolation, sleep, hobbies, sexuality, work, and social life. Each item has an answer ranged from 0 (never) to 4 (always). In this context, all responses were transformed into linear scale scores between 0 (no effect) and 100 (maximum effect). The total and three subscale score separately and a higher score indicate a lower quality of life. This questionnaire was developed by Chren et al. The Turkish adaptation of the Skindex-29 questionnaire was performed by Aksu et al.
Normality and variance were tested using the one-Sample Kolmogorov–Smirnov test for each variable. Quantitative data are presented as means and standard deviation, and qualitative data as frequency and percentage. Qualitative variables were analyzed using the Chi-square test. Age, height, weight, BMI, weight gain of primiparae and multiparae women, scale differences between striae presence and absence were compared by independent samples t-test. Scale score differences were analyzed using one-way ANOVA test, and post hoc comparisons were performed using Tukey's HSD test. Associations between striae severity and parity were performed by using the Spearman's rho correlation coefficient (ρ). Analyses were completed by using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 20.0 program. The statistical significance for all analyses was set at P < 0.05.
| Results|| |
A total of 164 patients were invited to involve in the study where four patients were excluded due to the uncompleted questionnaire and seven were excluded associated with missing values. Overall, 153 participants were included in this study. Of those 66 women (43.1%) were primiparae and 87 (56.9%) were multiparae. The demographic characteristics of the participants are presented in [Table 1].
The prevalence of striae gravidarum in total, primiparae and multiparae was 75.8% (116 in a total of 153), 66.7% (44 in a total of 66), and 82.7% (72 in a total of 87), respectively. Striae prevalence and the severity of striae according to Davey's score are presented in [Table 2]. Severe striae was observed 48.5% of primiparae women where 65.5% of multiparae (P > 0.05). However, a weak positive correlation was found between parity and striae severity (ρ = 0.190, P = 0.018).
The Skindex-29 score was ranged between 0 and 79, where the mean was 8.21 ± 12.3 in primiparae women and 10.3 ± 15.0 in multiparae (P > 0.05). The mean Skindex-29 score in women with striae was 9.82 ± 13.5 and 3.2 ± 3.3 without striae (P < 0.001). Since the mean score in primiparae women with and without striae were 13.8 ± 17.3 and 3.4 ± 3.8 (P < 0.001); 7.3 ± 10.2 and 2.9 ± 2.5 in multiparae women with and without striae (P = 0.001). The subscale scores (emotion, symptom, and functioning) of women with striae gravidarum were 3.73 ± 6.67, 4.62 ± 4.68, 1.54 ± 4.67, and 0.24 ± 1.18, 2.94 ± 2.6, 0 ± 0 in women without striae gravidarum (P < 0.001, P = 0.007, and P = 0.001, respectively). The mean symptom and emotion scale scores in women with severe striae were significantly higher than women without striae (P = 0.001, P = 0.039, respectively). The mean symptom and emotion scores in primiparae women with severe striae were significantly higher than women without striae (P = 0.001, P = 0.028, respectively). Skindex-29 scores of pregnant women by Davey's scoring is presented in [Table 3].
A total of 46 (30%) women applied cream/lotion into the abdominal area, and of those 32 was primiparae and 14 was multiparae. Cream/lotion use was significantly higher in primiparae as compared to multiparae (P = 0.001). The mean symptom and emotion scores of the women with striae gravidarum those applied cream were higher compared to nonusers [P < 0.001; P = 0.038, respectively; [Table 4] and [Table 5].
|Table 4: Skidex-29 scores of pregnant women who did or did not take preventive steps against striae gravidarum|
Click here to view
|Table 5: Skindex-29 scores of pregnant women with striae gravidarum in subgroups of those who did or did not take preventive steps|
Click here to view
| Discussion|| |
Striae is a significant factor affecting physical appearance during pregnancy period. Although these changes are accepted as physiological, it can cause anxiety forming undesirable body image accompanying by secondary changes during pregnancy. This anxiety may affect the quality of life with the difficulties in the effective treatment of striae.
The prevalence of striae gravidarum shows cultural diversity ranged between 39% and 90%.,,,, This study showed a prevalence of 74.8%, which is consistent with the findings obtained by Kartal Durmazlar et al. and Kılıc et al. Methods developed by Davey et al. and Atwal et al. are the most widely used tools to evaluate the severity of striae. This study assessing the severity of striae using Davey's method showed a weak positive correlation was existed between stria severity and parity which is consistent with the findings of Yamaguchi et al.
The Skindex-29 questionnaire accompanying its subscales evaluates the effects of skin diseases on the individual status of psychological, physical, and daily life. Despite nonlife-threatening characteristic of striae gravidarum, anxiety caused by inadequacy of the preventive techniques and long-term persistence of the lesions may affect the quality of life. Lansdorp et al. reported the Skindex-29 score of 38.4 in women with lichen sclerosis. Another study conducted to find the effects of Port-wine stain (on the face) on quality of life revealed a mean score of 24.6. Nijsten et al. categorized the Skindex-29 scores as I (very little; 0–5 points), II (mild; 6– 17 points), III (moderate; 18–36 points), and IV (severe; 37–100 points). According to this classification, the present study showed that quality of life of 16 women (51.7%) affected very little, 27.6% mild, and 20.7% moderate and greater. In addition, the mean Skindex-29 score was 13.8 ± 17.3, which is lower than the effect of other skin diseases, was found higher than women without striae. A study conducted by Yamaguchi et al. assessing the subscales of Skindex-29 demonstrated that emotion score in pregnant women and multiparae with severe striae was significantly higher. In contrast, the significant differences in all subscales of Skindex-29 in women with striae and without striae in the present study suggested that the presence of striae does not merely cause psychological stress due to cosmetic concerns and also leads to physical effects related to the symptoms it occurred. The significance in the subscales of women with striae and without striae can be caused by the instability of the acceptance of the disease creating skin changes in which may impair the cognitive and self-perception status of the individual. This hypothesis can be assessed by tools measuring self-perception and self-regard. In contrast to the findings of Yamaguchi et al. that inclined emotional score in multiparae women, the present study showed increased emotional score in primiparae suggesting worry about the first experience and progress of striae with the individual. A higher ratio of severe striae in multiparae women who have lower emotional impairment can be connected to the result of striae experience and learned helplessness. In addition, higher symptom score in women with striae compared to women without striae are associated with the symptoms including itching, burning sensations, and pain caused by striae.
Cream/lotion use is the most applied methods to prevent striae gravidarum. Despite the lack of strong evidence on the effect of cream/lotion use, some women apply cream/lotion during or after pregnancy to prevent or reduce the striae.,, The ratio of cream/lotion use in primiparae women is found as 63% in the USA, 61% in Lebanon, and 75% in Thailand.,, Yamaguchi et al. reported a cream use of 91.6% in primiparae women and 61.6% in multiparae. Although the cream use in primiparae was higher than multiparae in the present study, it is extremely low compared to the use in other countries. This finding suggested that women with pregnancy in Turkey have low levels of awareness and knowledge about moisturizing cream. Yamaguchi et al. concluded that cream/lotion use might improve quality of life by decreasing the impairment in psychological status of women with striae gravidarum and increasing the water level in stratum corneum, in spite of noneffectiveness to prevent striae. In the present study, women with a higher symptom score had cream/lotion use in which suggested that women with pregnancy usually have cream/lotion use habit for reducing the symptoms rather than routine.
Furthermore, higher symptom and emotion scores of women with striae those applied cream than nonusers can be associated with the physical and emotional status of women with striae. It can be speculated that cream/lotion use may be a predictive factor about the physical and emotional condition of the individual.
This study has several limitations. First, there are few studies evaluating the effects of striae gravidarum on quality of life, particularly dermatology. The present study is the first one conducted on the Turkish population. Therefore, we could not have the opportunity to compare the results of the current study with a previous one. Second, the sample size was calculated with the previous studies on different diseases except for striae gravidarum and could be larger to increase the possibility of generalizability of the findings. Third, the effect of striae gravidarum on quality of life may be affected by both cultural variations and living in urban/rural areas, thus restricting the generalizability of the study outcomes.
| Conclusions|| |
Striae gravidarum minimally affects quality of life of Turkish women. This effect is evident particularly in severe disease. Striae affect not only the emotional but also both of the physical and daily life of the individual. Therefore, women suffer from striae should be examined in detail to prevent the development or progression of striae, particularly in women encountered for the first time or primiparae with severe striae those might be intensely affected. Cream use does not impair the emotional condition in women with striae gravidarum. This finding pointed the concerns of the women with pregnancy about the effectiveness of the methods they applied. Therefore, there is a need for alternative methods to prevent striae. Further studies on different regions of various populations are required to enhance the knowledge on the effects of striae gravidarum on quality of life.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Salter SA, Kimball AB. Striae gravidarum. Clin Dermatol 2006;24:97-100.
Tunzi M, Gray GR. Common skin conditions during pregnancy. Am Fam Physician 2007;75:211-8.
Kartal Durmazlar SP, Eskioglu F. Striae gravidarum: Associated factors in Turkish primiparae. J Turk Acad Dermatol2009;3:1-5.
Kılıc A, Cakmak S, Atalay C, Atıcı E, Er O, Yakut K, et al
. Development of stria gravidarum in pregnant women and associated factors. Turkderm 2015;49:95-100.
Ersoy E, Ersoy AO, Yasar Celik E, Tokmak A, Ozler S, Tasci Y, et al.
Is it possible to prevent striae gravidarum? J Chin Med Assoc 2016;79:272-5.
Farahnik B, Park K, Kroumpouzos G, Murase J. Striae gravidarum: Risk factors, prevention, and management. Int J Womens Dermatol 2017;3:77-85.
Korgavkar K, Wang F. Stretch marks during pregnancy: A review of topical prevention. Br J Dermatol 2015;172:606-15.
Yamaguchi K, Suganuma N, Ohashi K. Quality of life evaluation in Japanese pregnant women with striae gravidarum: A cross-sectional study. BMC Res Notes 2012;5:450.
Yamaguchi K, Suganuma N, Ohashi K. Prevention of striae gravidarum and quality of life among pregnant Japanese women. Midwifery 2014;30:595-9.
Kagawa-Singer M, Padilla GV, Ashing-Giwa K. Health-related quality of life and culture. Semin Oncol Nurs 2010;26:59-67.
Gibbons CJ, Skevington SM; WHOQOL Group. Adjusting for cross-cultural differences in computer-adaptive tests of quality of life. Qual Life Res 2018;27:1027-39.
Davey CM. Factors associated with the occurrence of striae gravidarum. J Obstet Gynaecol Br Commonw 1972;79:1113-4.
Chren MM, Lasek RJ, Flocke SA, Zyzanski SJ. Improved discriminative and evaluative capability of a refined version of skindex, a quality-of-life instrument for patients with skin diseases. Arch Dermatol 1997;133:1433-40.
Aksu AE, Urer MS, Sabuncu I, Saracoglu ZN, Chren MM. Turkish version of skindex-29. Int J Dermatol 2007;46:350-5.
Brown A, Rance J, Warren L. Body image concerns during pregnancy are associated with a shorter breast feeding duration. Midwifery 2015;31:80-9.
Chang AL, Agredano YZ, Kimball AB. Risk factors associated with striae gravidarum. J Am Acad Dermatol 2004;51:881-5.
Ghasemi A, Gorouhi F, Rashighi-Firoozabadi M, Jafarian S, Firooz A. Striae gravidarum: Associated factors. J Eur Acad Dermatol Venereol 2007;21:743-6.
Picard D, Sellier S, Houivet E, Marpeau L, Fournet P, Thobois B, et al.
Incidence and risk factors for striae gravidarum. J Am Acad Dermatol 2015;73:699-700.
Atwal GS, Manku LK, Griffiths CE, Polson DW. Striae gravidarum in primiparae. Br J Dermatol 2006;155:965-9.
Lansdorp CA, van den Hondel KE, Korfage IJ, van Gestel MJ, van der Meijden WI. Quality of life in Dutch women with lichen sclerosus. Br J Dermatol 2013;168:787-93.
Hagen SL, Grey KR, Korta DZ, Kelly KM. Quality of life in adults with facial port-wine stains. J Am Acad Dermatol 2017;76:695-702.
Nijsten T, Sampogna F, Abeni D. Categorization of skindex-29 scores using mixture analysis. Dermatology 2009;218:151-4.
Osman H, Usta IM, Rubeiz N, Abu-Rustum R, Charara I, Nassar AH, et al.
Cocoa butter lotion for prevention of striae gravidarum: A double-blind, randomised and placebo-controlled trial. BJOG 2008;115:1138-42.
J-Orh R, Titapant V, Chuenwattana P, Tontisirin P. Prevalence and associate factors for striae gravidarum. J Med Assoc Thai 2008;91:445-51.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]