STRATEGY OF TREATMENT OF PRURITUS DURING PREGNANCY

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.