LETTERS

RESEARCH LETTERS

Incidence and risk factors for striae
gravidarum
To the Editor: Striae gravidarum represent an important
aesthetic concern for pregnant women. Because risk
factors for striae gravidarum have not been consistent
in the literature, we have analyzed predictors for
the development of striae gravidarum during preg-
nancy.1-5 During a 4-month period, 800 consecutive
primiparas from 3 obstetric departments in Rouen,
France, were examined postpartum for the presence
of striae gravidarum by the same dermatologist.
Socioeconomic and clinical parameters were collected.
Striae gravidarum predictors were compared between
women with striae gravidarum and women without
striae gravidarum. Univariate analysis was performed
based on the Student t test for continuous factors and
either Pearson 2 test or Fisher exact test for categorical
factors. Multivariate logistic regression was performed
to select factors independently associated with occur-
rence of striae gravidarum.

Table I. Clinical features and socioeconomic characteristics at baseline of pregnant women according to
striae gravidarum development during pregnancy
Comparison between women with and without SG
All women Women with Women without
(n = 800) SG (n = 447) SG (n = 353) P
Age, y 26.3 6 4.8 24.5 6 4.0 28.8 6 4.7 \.0001
\20 51 (6%) 43 (9%) 8 (2%) \.0001
20-24 255 (32%) 201 (45%) 54 (15%)
25-29 299 (37%) 155 (35%) 144 (41%)
$30 195 (25%) 47 (10%) 148 (42%)
Unemployment 179 (22%) 118 (26%) 61 (17%) .0021
Private insurance 706 (88%) 388 (87%) 318 (90%) .17
Phototype
I 162 (20%) 110 (25%) 52 (15%) .0002
II 327 (41%) 177 (39%) 150 (42%)
III 178 (22%) 80 (18%) 98 (28%)
IV 133 (17%) 80 (18%) 53 (15%)
Prepregnancy weight, kg 62.3 6 12.9 65.5 6 14.2 58.1 6 9.6 \.0001
Prepregnancy body mass index, kg/m2 23 6 4.4 24.1 6 4.9 21.4 6 3.3 \.0001
Weight at delivery, kg 76.8 6 13.9 81.1 6 14.3 71.5 6 9.8 \.0001
Gestational weight gain, kg 14.6 6 5.3 15.6 6 5.7 13.4 6 4.3 \.0001
Neonate birth weight, g 3246 6 573 3321 6 551 3151 6 587 \.0001
Neonate male gender 392 (49%) 212 (47%) 180 (51%) .31
Term at delivery, wk 39.4 39.6 39.2 .019
Polycystic ovarian syndrome 17 (2%) 10 (2%) 7 (2%) .80
Presence of stretch marks before pregnancy 415 (52%) 230 (51%) 185 (52%) .78
Family history of stretch marks/SG* 437/501 295/309 142/192 \.0001
Multiple gestation pregnancy 14 (1%) 11 (2%) 3 (1%) .08
Fertility treatment 43 (5%) 22 (5%) 21 (6%) .52
Acne gravidarum 193 (24%) 117 (26%) 76 (21%) .12
Corticosteroid treatment 34 (4%) 20 (5%) 14 (4%) .72
Lowered glucose tolerance/diabetes mellitus 90 (11%) 50 (11%) 40 (11%) .60
Hydramnios 11 (1%) 9 (2%) 2 (1%) .12
Fundal height at delivery, cm 32.4 32.9 31.7 \.0001
Preventive treatment of SG 616 (77%) 348 (78%) 268 (76%) .52
Cream 482 (60%) 289 (64%) 193 (54%) .003
oil 72 (9%) 27 (6%) 45 (13%)
Cream 1 oil 62 (8%) 32 (7%) 30 (8%)

Data re mean 6 SD or n (%).

SG, Striae gravidarum.
*Based only on reliable answers (n ¼ 501) from the questionnaire.

J AM ACAD DERMATOL OCTOBER 2015 699

700 Letters J AM ACAD DERMATOL
OCTOBER 2015

Table II. Risk factors for striae gravidarume
multivariate analysis
95%
Confidence
Odds ratio interval
Age classification, y
Reference $30 1 \.0001
25-29 3.43 2.21-5.34
20-24 12.85 7.85-21.04
\20 24.61 9.96-60.77
Higher prepregnancy 1.25 1.19-1.32 \.0001
body mass index/U
Gestational weight gain/kg* 1.13 1.09-1.17 \.0001
Multiple gestation 5.35 1.19-23.94 .028
pregnancy
*Compared with prepregnancy.
Mean age of women was 26.3 6 4.8 years with
6% of women being younger than 20 years, 69%
between 20 and 30 years, and 25% older than
30 years (Table I). The overall incidence of striae
gravidarum that occurred during the first preg-
nancy was 56% (95% confidence interval [CI] 52%-
59%). Striae gravidarum occurred on the following
sites: abdomen (70%), hips and thighs (41%), and
breast (33%). Mean 6 SD prepregnancy weight
and body mass index were 62.3 6 12.9 kg and
23 6 4.4 kg/m2, respectively. Mean pregnancy
weight gain was 14.6 6 5.3 kg. Women with striae
gravidarum were younger than those with no
striae gravidarum (24.5 vs 28.8 years,
P \ .0001). According to age, 84% of women
younger than 20 years developed striae gravida-
rum, as compared with 24% of women aged
30 years and older (P \ .0001). Other predictors
for developing striae gravidarum were: higher
prepregnancy weight (P \ .0001) and body mass
index (P \ .0001), higher weight at delivery
(P \ .0001), higher gestational weight gain
(P \ .0001), Fitzpatrick skin types I and IV
(P ¼ .0002), absence of employment
(P ¼ .0021), and family history of striae gravida-
rum (P \ .0001). Twin pregnancies (n ¼ 14) were
more frequent in women with striae gravidarum
(79%) than in those without striae gravidarum
(21%) with borderline significance (P ¼ .08). Birth
weight was slightly higher (P \ .0001) and
gestation time was slightly longer (P ¼ .019) in
women with striae gravidarum than in those
without striae gravidarum.
Using multivariate analysis, risk factors of striae
gravidarum were either related to: (1) patient char-
acteristics, ie, younger age (odds ratio [OR] 28.25 for
women age \20 years considering the reference
women [30 years, 95% CI 11.04-72.27), higher
prepregnancy body mass index (OR 1.25/U, 95% CI
1.19-1.32), and phototypes I (OR 2.01, 95% CI 1.16-
3.49) and IV (OR 1.91, 95% CI 1.09-3.34) as
P value compared with phototype III; or (2) pregnancy
characteristics, ie, gestational weight gain (OR 1.12/
kg, 95% CI 1.07-1.16) and multiple gestation preg-
nancy (OR 10.02, 95% CI 1.94-51.59) (Table II). Use
of topical treatments to limit the occurrence of striae
gravidarum was not found to be effective.
Overall, this study shows that occurrence of
striae gravidarum is not only associated with young
age and family or genetic factors such as family
history and skin phototype, but also with risk factors
such as prepregnancy weight and weight gain
during pregnancy. These risk factors may support
effective patient counseling, especially among
younger women, to prevent occurrence of striae
gravidarum during pregnancy.
Damien Picard, MD, PhD,a S
e verine Sellier, MD,a
Estelle Houivet, PhD,c,d Loic Marpeau, MD,
PhD,b Patrick Fournet, MD,e Bernard Thobois,
MD,f Jacques B
enichou, MD, PhD,c,d and Pascal
Joly, MD, PhDa
Departments of Dermatologya and Obstetricsb and
Biostatistics Unit,c Rouen University Hospital,
INSERM U 905, University of Rouen; Inserm U
657, University of Rouend; Department of Ob-
stetrics, Centre Hospitalier du Belv
ede re, Mont
Saint Aignane; and Department of Obstetrics,
Clinique Mathilde, Rouen,f France
Funding sources: None.
Conflicts of interest: None declared.
Correspondence to: Pascal Joly, MD, PhD, Clinique
DermatologiqueeCHU de Rouen, H^opital Charles
Nicolle, 1 rue de Germont, F 76031 Rouen cedex,
France
E-mail: Pascal.Joly@chu-rouen.fr
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http://dx.doi.org/10.1016/j.jaad.2015.06.037