OBJECTIVE: To present a procedure for establishing treatment guideline
s during pregnancy and, as an application of the method, the recommend
ations for treatment of pruritus. DESIGN: A preliminary survey was car
ried out among participants of the study group to determine drug choic
es for treatment of pruritus during pregnancy. Literature data on the
selected drugs were analyzed. Recommendations for treatment were propo
sed, taking into account the most efficient agents and the least toxic
for the fetus. This draft was submitted to all participants of the st
udy group; criticism and suggestions were gathered. A new draft was ev
olved and repeatedly submitted to participants until consensus was rea
ched. SETTING: Study group set up in southwestern France, with the hel
p of national experts. PARTICIPANTS: Forty-three general practitioners
, six gynecologists and/or obstetricians, five pharmacologists, two de
rmatologists, and an embryologist. RESULTS: The main recommendations f
or treatment of pruritus during pregnancy are to begin with topical tr
eatment: emollient bath additives, moisturizing cream, talc. If insuff
icient, a systemic treatment should be added. Antihistamines are presc
ribed first: hydroxyzine or dexchlorpheniramine is used during the fir
st 2 months. From the third month, die same agents can be used, as can
mequitazine. The duration of treatment can be up to 10 days. The grou
p's second choice was benzodiazepine (oxazepam) as second-line treatme
nt. CONCLUSIONS: Strategies for treatment of diseases during pregnancy
are not always well defined. For many common diseases, very few data
are available concerning drug use in pregnant women. The study group,
based on consensus among participants, proposed treatment guidelines.