Strategy of treatment of pruritus during pregnancy. The Drugs and Pregnancy Study Group

OBJECTIVE: To present a procedure for establishing treatment guidelines during pregnancy and, as an application of the method, the recommendations for treatment of pruritus. DESIGN: A preliminary survey was carried out among participants of the study group to determine drug choices for treatment of pruritus during pregnancy. Literature data on the selected drugs were analyzed. Recommendations for treatment were proposed, taking into account for most efficient agents and the least toxic for the fetus. This draft was submitted to all participants of the study group; criticism and suggestions were gathered. A new draft was evolved and repeatedly submitted to participants until consensus was reached. SETTING: Study group set up in southwestern France, with the help of national experts. PARTICIPANTS: Forty-three general practitioners, six gynecologists and/or obstetricians, five pharmacologists, two dermatologists, and an embryologist. RESULTS: The main recommendations for treatment of pruritus during pregnancy are to begin with topical treatment; emollient bath additives, moisturizing cream, talc. If insufficient, a systemic treatment should be added. Antihistamines are prescribed first: hydroxyzine or dexchlorpheniramine is used during the first 2 months. From the third month, the same agents can be used, as can mequitazine. The duration of treatment can be up to 10 days. The group's second choice was benzodiazepine (oxazepam) as second-line treatment. 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.