Prevention of striae gravidarum
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Date
2020-04-30Author
Brennan, Miriam
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Abstract
Introduction
Striae gravidarum, or stretch marks, are a common physiological skin change occurring during pregnancy. They improve postpartum, but do not disappear fully. While their cause remains unclear, many associated risk factors have been identified. In addition to their physical effect, they are known to cause other symptoms and to affect women psychologically. They are seen commonly as an aesthetic or cosmetic issue and by some as disfiguring, and can be distressing for women. Further, there is a growing body of evidence of their effects on women’s quality of life. Many women apply one or more of the many topical products available to their skin in efforts to prevent striae gravidarum, but many of these products have not been evaluated and there is a dearth of high-quality evidence of effectiveness on any of the topical products used by women.
The thesis aims are:
1. to systematically review the evidence of the effectiveness of topical preparations in the prevention and reduction in severity of striae gravidarum;
2. to survey women on their use of skin products to prevent or reduce the development of striae gravidarum, and
3. to undertake a pilot randomised trial to evaluate the feasibility of conducting a large trial on the effectiveness of a moisturising oil (commercially available) compared to no treatment for the prevention and reduction in severity of striae gravidarum.
Methods
This thesis includes four papers. A Cochrane systematic review and meta-analysis was undertaken to evaluate the evidence for the effectiveness of topical preparations in the prevention and reduction of striae gravidarum (Question 1, Chapter 2). This was followed by a cross-sectional descriptive survey, which identified the topical products commonly used (Question 2, Chapter 3). The protocol for the pilot randomised trial to evaluate the feasibility of conducting a large trial on the effectiveness of a moisturising oil compared to no treatment (Question 3, Chapter 4) followed. It was informed by the findings of the survey and the literature. However, despite amendments to the protocol and a
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collaborative effort to recruit women, recruitment was difficult. This prompted exploration of the factors influencing recruitment to the trial (Question 4, Chapter 5).
Results
The Cochrane systematic review and meta-analysis found that that there was no statistically significant average difference in the development of stretch marks in women who received topical preparations with active ingredients compared to women who received a placebo or no treatment, and that there was no statistically significant average mean difference in the severity of stretch marks. Similarly, there was no statistically significant average difference in the development of stretch marks in women who received topical preparations with active ingredients compared to women who received other topical preparations with active ingredients and there was no statistically significant difference in the severity of stretch marks. The review concluded that there is a clear need for robust, methodologically rigorous randomised trials involving larger sample sizes to evaluate the effects of topical preparations on the development of stretch marks in pregnancy.
In the cross-sectional descriptive survey, most respondents (n = 589, 78.2%) indicated that they used a product to prevent or reduce the development of stretch marks during their current pregnancy. A large range of products was used, and more than one-third of women (n = 210, 36.5%) had used two or more products. Furthermore, a majority of women, 68.3% (n = 514), indicated that they would consider participating in a future trial of a product to prevent or reduce stretch marks in pregnancy.
The pilot trial experienced significant challenges with recruitment and therefore no summative evaluation was possible. From participants’ response to the pilot trial which was investigated in the qualitative study, it is not possible to conduct a definitive randomised controlled trial to evaluate the effectiveness of a moisturising oil (commercially available) compared to no treatment. The qualitative descriptive study found that striae gravidarum prevention is important to women; many knew what product they were going to use, had purchased it
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and in some cases had started using it. In relation to influences on trial participation, the possibility of being randomised to the non-intervention or control group was a deterrent for many women.
Conclusion
Striae gravidarum prevention is important to women, and many make their product choice out of the healthcare setting, influenced by friends and family. Although this thesis identified the need for robust, methodologically rigorous randomised trials involving larger sample sizes to evaluate the effects of topical preparations, the pilot trial identified challenges with undertaking such a study, while the qualitative study highlighted issues that must be overcome before embarking on this course of research.