Pregnancy can interrupt many facets of life, but one especially distressing issue can be its impact on cosmetic treatments. With all the changes that pregnancy brings to the body, one thing many women want to be able to maintain is their skincare routine. The essential question then becomes which products and treatments are safe and which should be avoided during pregnancy?
Skin, like many body parts, is affected by pregnancy. Pigment can become darker, skin becomes more oily leading to acne, stretch marks can form, hair grows thicker, and skin can become itchy. Fortunately, most of these changes resolve on their own within weeks after delivery.
When addressing these concerns, the first relevant issue to discuss is timing. The different stages of pregnancy carry different risks. The first trimester is the most essential phase of pregnancy for most exposure issues because during the first trimester all of a baby’s organs are forming and this is the time when most birth defects can occur. All pregnancies have a 3-5% risk of birth defects, which is called the background risk. The question with any exposure is whether it increases the risk of birth defects above the background risk. Once the first trimester has ended, organs are continuing to develop into their fully functional forms and so their function (even if not their structure) can still be affected.
Like all exposures, the dosage is key. While a chemical might be perfectly safe in small amounts, it could be harmful in larger amounts. Often, this is not well studied and remains unknown. However, it is generally reasonable to assume that smaller exposures are safer than larger ones.
Safety in pregnancy is not only related to birth defects. Other risks to consider include miscarriage, preterm delivery, abnormal fetal growth, and developmental or behavioral delays (the brain is developing and maturing throughout pregnancy even though it was already formed in the first trimester). These are all potentially relevant in the second and third trimesters until delivery.
At the outset it is important to recognize that most products contain many ingredients and while there may be data on some, there often is a lack of data regarding others. The many skincare routines that have become popular are often made with large numbers of ingredients, some of which may be unsafe during pregnancy. Another problem is that there is little oversight of the industry and therefore products—other than actual medications which are strictly monitored — may not contain the ingredients they claim. There have been many cases of products being found to contain few or none of their supposed active ingredients, or instead including harmful ingredients. For these reasons, many skincare products are best avoided during pregnancy.
Basic soaps and moisturizers are generally safe to use. Sunscreens that are mineral based (zinc oxide or titanium dioxide) are safe to use in pregnancy. Sun protection is especially important during pregnancy as the skin changes in pregnancy can make it more susceptible to burning and damage. Products that are designed for treating spots or the various serum products become more problematic. These often contain long lists of ingredients, and sometimes items listed as “proprietary blends” or otherwise vague identification.
One of the most common skin issues in pregnancy is an increase in acne. Acne has topical as well as oral treatments. The preferred options are topical use of benzoyl peroxide, azelaic acid, salicylic acid, or glycolic acid. While there is limited data on these treatments, existing data show no increased risk of complications. Only very tiny amounts are absorbed through the skin and thus the exposure to the baby, if any, would be extremely small.
There are, however, acne treatments that are off-limits during pregnancy. It is well documented that oral use of isotretinoin (most commonly known as Accutane) poses a very high risk during pregnancy. The risk of birth defects may be as high as 35% with also increased risk of miscarriage and early delivery. Isotretinoin is therefore absolutely off-limits in pregnancy.
Tretinoin and retinol are available as topical treatments for acne (as well as in many skincare routines). They are both related to isotretinoin, so their use during pregnancy is also advised against. Although there is limited data on topical use, there may be an increased risk of birth defects and given the well-documented dangers of isotretinoin it is advised to not use topical tretinoin or retinol in pregnancy.
Itchy skin can rarely be a serious condition, so it should be brought to your doctor’s attention, but more commonly it is just an annoyance. The dry, cold air of winter causes more itching. For some women showering in very hot water worsens it, so it can be helpful to shower in cooler water. Moisturizing dry skin is essential.
Unfortunately, one skin condition that does not have any treatments that have been shown to work well is stretch marks. They can become itchy and the same treatments for itching can be helpful. They will usually fade somewhat on their own after pregnancy, sometimes completely. But despite all the sales pitches on the internet, there is no real evidence to support the claims.
The skin, as the body’s largest organ, undergoes significant changes during pregnancy. Some issues are easily treated, but sometimes not in the same way they can be safely treated outside of pregnancy. It is always a good idea to ask your doctor because people are often surprised by what treatments they may, or may not, be allowed to use during pregnancy. Another excellent, evidence-based resource is mothertobaby.org, which compiles information on all kinds of exposures in pregnancy, from medications to foods and the environment.
Dr. Yoni Ratzersdorfer is a board-certified OB/GYN who has been in practice in New Jersey since 2015. He is a strong believer in supporting women’s birth choices to achieve the birth they desire. He is a physician at Maternal Resources, a thriving boutique style practice with offices in Hackensack, Jersey City, Hoboken, Howell and New York City.
