Vitiligo, a worrying-sounding word, should not be a stumbling block for expectant mothers trying to conceive a new life. 

First of all, it needs to be clear that the genetic probability of vitiligo is not high, and only a single genetic factor can not lead to the onset of vitiligo. A clinical survey of 6,199 vitiligo patients and their relatives showed [1] that the prevalence of vitiligo among Han Chinese was 0.19%, while the probability of first-degree relatives of vitiligo patients (such as parents, children, or siblings) having vitiligo was only 3.3%. Patients need not be overly anxious about genetic problems. 

Secondly, vitiligo itself has no direct impact on fertility, will not cause sperm, egg abnormalities that can not be normally combined, but will slightly affect the pregnancy outcome. A study on the pregnancy outcomes of vitiligo patients [2] showed that the spontaneous abortion rate (14.7%) of vitiligo patients was slightly higher than that of the normal population (12.1%), and the live birth rate (66.1%) was lower than that of the normal population (68.9%). 

However, vitiligo is not a contraindication of pregnancy. Vitiligo patients can have a healthy baby before and during pregnancy, as long as they do their daily care work and consult a doctor about the follow-up risks of pregnancy. 

I hope you can find some tips on the problems that expectant mothers may encounter when trying to conceive or during pregnancy. 

When is it appropriate to get pregnant? 

During pregnancy, expectant mothers need to strictly avoid factors that may have adverse effects on fetal development or teratogenic factors, and the treatment of vitiligo is often inseparable from hormones, immunomodulators, photosensitizers, Chinese medicine and other drugs, which may have adverse effects on fetal development. Therefore, it should not be used during pregnancy. 

In order to avoid the spread of white spots during pregnancy and the situation that cannot be treated in time, it is recommended that expectant mothers consider the pregnancy plan after the condition enters a stable period. 

In addition, expectant mothers should check with their doctor before trying to get pregnant to determine if medication during treatment will affect pregnancy planning. From the point of view of eugenics and fertility, it is recommended that patients adjust their pregnancy preparation time reasonably under the guidance of doctors or consider pregnancy preparation after stopping the drug for 3-6 months. 

Second, can breast-feeding be treated while breast-feeding? 

Patients with vitiligo can breastfeed their children while being treated during lactation. Because vitiligo is not an infectious disease, it is not passed to the baby through breast milk, so patients can breastfeed with peace of mind. 

It should be noted that the choice of treatment during lactation is very important, and almost all drugs can enter the milk and be absorbed by the baby. Patients who choose drug treatment during lactation should be careful and should follow the doctor's advice to avoid unauthorized use of drugs to ensure the health of the mother and child. 

It is worth mentioning that NB-UVB phototherapy as a physical therapy is a relatively safe treatment option for lactating patients. 

Third, how to prevent the spread of white spots during pregnancy? 

Hormone levels in pregnant and lactating mothers fluctuate greatly, and hormones can affect the immune response, so it is likely to aggravate immune disorders in the body, leading to the spread of white spots. At the same time, there is no timely treatment and intervention during pregnancy, which has a great negative impact on the life of patients. 

In order to avoid the above difficulties, patients should do the following during pregnancy and lactation: 

1. Ensure a balanced nutritional intake 

Vitiligo patients need to pay attention to the balance of nutrition, in view of vitiligo patients themselves there are trace elements and nutritional deficiencies, at the same time coincides with the increase in nutritional demand during pregnancy, it is recommended that expectant mothers have a balanced diet, no special diet, to ensure that the fetus needs adequate nutrition. 

Regarding the hotly debated issue of vitamin C, moderate intake of high-vitamin C foods is not harmful, but excessive use of vitamin C supplements (such as: vitamin C tablets, drinks, intravenous injections, etc.) should be avoided to prevent adverse effects. 

2. Be happy 

Due to hormonal fluctuations during pregnancy, the patient's mood is prone to ups and downs. Often appear anxiety, panic, tension and other negative emotions. For vitiligo patients, long-term negative emotions will cause the hypothalamic-pituitary-adrenal cortical axis (HPA) reactivity imbalance, release excessive serum cortisol, inhibit the synthesis and secretion of inflammatory factors, and then inhibit melanocyte differentiation and tyrosinase activation [3], ultimately leading to the occurrence and development of vitiligo. 

Therefore, expectant mothers adjust and maintain a good mood during pregnancy and lactation, which is conducive to the health of the child and also conducive to the recovery of the condition. 

3. Get plenty of rest 

Among the reasons for the spread of vitiligo during pregnancy, lack of sleep is often overlooked. Pregnant mothers due to physical discomfort, often appear difficult to fall asleep, sleep discontinuity and other conditions, resulting in lack of sleep; Breastfeeding mothers need to get up frequently at night to feed their babies, which can also lead to sleep deprivation. 

Long-term sleep deprivation will increase the level of inflammatory factors in the body (such as IL-17, TNF-α, etc.) [4], which play an important role in the pathogenesis and development of vitiligo. Increased secretion of such inflammatory factors will aggravate the level of inflammation in patients with vitiligo and may affect the recovery and process of the disease. 

It is recommended that pregnant patients adjust their sleeping position in time and use auxiliary pillows to relieve discomfort; Nursing patients may consider family members to assist with night feeding to ensure adequate rest. Only when your own state is good, can you better accompany your children. 

Fourth, can pregnant women receive light therapy? 

The immune homeostasis and hormone levels of expectant mothers fluctuate greatly during pregnancy, so the choice of treatment needs to be cautious. 

Given that the early stage of pregnancy (especially the first 3-6 months) is a critical stage of fetal development, unless there is a special progression of the disease, it is not recommended that pregnant women undergo any form of drug therapy or phototherapy to avoid potential risks. If there is a special situation, pregnant women should also consult the doctor, under the guidance of the doctor for treatment, do not use drugs without authorization, light therapy. 

When the fetus enters a more stable stage of development, if treatment intervention is really needed, pregnant women can consider using local NB-UVB ultraviolet light therapy under the guidance of professional doctors. This local phototherapy treatment has a less severe impact on the body system of pregnant women than drug therapy, and NB-UVB phototherapy only penetrates into the upper dermis, which is considered a relatively safe treatment option. Therefore, when pregnant women cannot use other treatment options, local NB-UVB ultraviolet light therapy or a treatment option that can be explored at a specific stage of pregnancy.