You might assume a beauty editor like myself with 15 years of experience would know the ins and outs of every skin-care ingredient. But let me tell you, pregnancy is a different ball game. I was pregnant for most of the past three years, and I still found myself googling and texting my derm friends about ingredients I could and couldn’t use. I’m also the skin-care resource for many friends, so I’m hyper-aware of giving solid advice, especially when someone is expecting. The one question I get most often: What’s the deal with retinol? You may think the answer is no, but don’t freak out if it happens. (Read why below.)
Retinol isn’t the only questionable ingredient. Like me, many of my peers have been disappointed at the lack of information from their OB-GYN about ingredients to avoid. I commonly hear: “she told me to ask my dermatologist.” That’s not exactly reassuring when your dermatologist says “always defer to an OB-GYN before using any topical skin-care product while you’re pregnant,” as Beverly Hills, CA dermatologist Ava Shamban, MD notes. Here, we break down the pregnancy no-no list.
Why It’s Important to Avoid Certain Skin-Care Ingredients While Pregnant
“Our skin is our largest organ, functioning as a filter that helps to remove toxins and and prevent entry from pathogens and unhealthy environmental factors,” Dr. Shamban explains. “That said, there is always a chance of active ingredient absorption. The issue, of course, is whether or not a specific topical product will be absorbed systemically. The vast majority of skin-care products are in fact not expected to increase the risk of pregnancy malformations or other adverse effects on the developing fetus from exposures.” However, these are the few to stay away from.
Retinol While Pregnant: What to Know
This is the big one dermatologists will tell you to avoid, but the effects of topical retinol on a fetus have actually never been studied. (I’m not sure I know any moms-to-be who would willingly participate in such a study, hence the reason it hasn’t been done.) Therefore, the recommendation that women should not be encouraged to use topical retinoids during pregnancy is out of an abundance of caution. This cautionary tale stems from the effects of other vitamin A derivatives and oral acne medication Accutane on a fetus, which have been proven.
Oral and Transdermal Retinoids and Retinol Use
“Tretinoin and a range of formats of Retin-A—retinol and retinyl palmitate, which are derivatives of vitamin A—can be dangerous to expecting mothers if used orally or transdermally, as they can cause birth defects,” says Dr. Shamban. “Called fetal retinoid syndrome, it is rare and purported to require high levels of the ingredient. There is risk at any exposure or risk to the developing embryo and fetus. More research and studies need to be done to know the specific dosages, specific manifestation and long-term effects of exposure. Additionally, we need to know how long prior to pregnancy they need to discontinue using the ingredient to ensure they are not threatened. Defects associated with the product interaction include growth and development delays. There could also be eye, ear and head abnormalities, as well as fluid on the brain.”
Topical Retinoids and Retinol During Pregnancy: OTC Products Vs. Accutane
On the other hand, when using retinol topically, some dermatologists don’t think there’s cause for concern. “Retinol is one ingredient that most dermatologists would say to avoid. This is mostly because of the connection between it and oral isotretinoin, aka Accutane,” says New York dermatologist Doris Day, MD. “However, retinol is vitamin A, and when applied to a small surface area like the face, there is likely very little absorption. It’s much less than what we take in neonatal supplements and foods. In my opinion, over-the-counter retinol products used on the face are generally considered to be safe during pregnancy. [This does not include topical tretinoin, available via prescription.] I think of it more as a medico-legal issue rather than a true medical threat to the fetus.” However, these days there are many safe alternatives with retinol-like effects, such as bakuchiol, rambutan and rosehip oil, that can be swapped into a routine instead.
Tazarotene, which is a retinoid used for treating acne and psoriasis, should also be avoided during pregnancy, says Dr. Day. “It has a pregnancy category X rating, which means it is contraindicated in pregnancy. This is a prescription product that was originally approved for the treatment of psoriasis, which means it was generally used over a larger body surface area. And in that case, absorption would be more of an issue, but it’s still not recommended for use during pregnancy.”
The bottom line with retinol use: Most doctors will recommend only starting back on retinol when you are no longer pregnant or breastfeeding. The community consensus is to err on the side of caution.
Salicylic Acid Use During Pregnancy
“Salicylic acid is in the aspirin family, and when absorbed during pregnancy, it can cause salicylism in the mom, and also intracranial bleeding,” explains Dr. Day. “If you use it in concentrations over 2 percent, avoid doing so in pregnancy. I would also avoid chemical peels with this ingredient. They are higher-concentration and used over a large area of the body. But, salicylic acid is considered safe when in a cleanser at a concentration of 0.5 to 2 percent. Or, as a spot-treatment.” Hydrocolloid patches can work wonders on pimples as well, and are perfectly safe to use during pregnancy and breastfeeding.
Benzoyl Peroxide Use During Pregnancy
Dr. Day says this “falls into pregnancy category C [animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks], but data shows that when used in lower concentrations of 2.5 to 5 percent, it is safe in pregnancy.”
One Canadian study analyzed the safety of skin care during pregnancy. Results showed that “when benzoyl peroxide is applied topically, only 5 percent is absorbed through the skin. Then it is completely metabolized to benzoic acid within the skin and excreted unchanged in the urine. No studies on the use of this preparation in pregnant patients have been published. However, systemic effects on a pregnant woman and her child would not be expected. Therefore, use of this product during pregnancy would not be of concern.”
The Risks of Using Hydroquinone When You’re Expecting
Hydroquinone is of the most effective skin-lighteners for stubborn hyperpigmentation, but it should not be used during pregnancy or breastfeeding. “It is a highly effective agent used to shrink melanocytes, as it inhibits the tyrosinase pathway. But, it should not be used by pregnant women,” says Delray Beach, FL dermatologist Dr. Janet Allenby. In September 2020, over-the-counter hydroquinone products were banned in the United States. This was a result of the CARES Act (the Coronavirus Aid, Relief, and Economic Security Act). Any such products now require an FDA-approved new drug application before they can be legally marketed. In the office, however, doctors can still prescribe it.
In the same Canadian study mentioned above, researchers reported, “it has been estimated that 35 to 45 percent [of hydroquinone] is systemically absorbed following topical use in humans. A single study has been published involving the use of hydroquinone during pregnancy with no increase in adverse events. However, the sample size of pregnant women was small. Based on available data, hydroquinone use during pregnancy does not appear to be associated with increased risk of major malformations. However, because of substantial absorption compared with other products, it is best to minimize exposure until further studies can confirm safety.”
Formaldehyde Exposure During Pregnancy
Formaldehyde has been removed from most nail polishes on the market today. However, if you get your hands on an unknown brand of polish, look at the ingredients closely. Nail hardeners, nail polish removers, some keratin hair treatments and eyelash glue may also contain formaldehyde. There are also formaldehyde releasers, such as quaternium 15, DMDM hydantoin and methylene glycol. “Exposure to formaldehyde has been linked to higher risk of congenital anomalies. It’s also associated with lower than normal birth weights and premature birth,” says Dr. Shamban.
Can You Use Chemical Sunscreen During Pregnancy?
Dermatologists tend to disagree on this one. Some doctors, including Dr. Shamban, are of the mindset that chemical sunscreens aren’t so bad. “They are fine to use because there is minuscule risk of systemic adaption,” she says. Active ingredients in these sunscreens include avobenzone, homosalate, octisalate, octocrylene, oxybenzone, and octinoxate. (Note: Most brands have reformulated their sunscreens to be free of oxybenzone in recent years.) Others recommend sticking to physical sunscreens that use active ingredients zinc oxide and/or titanium dioxide. “To be safe, I advise my pregnant patients to use natural, physical sunblock instead of chemical,” says Dr. Allenby.
According to a study published in Reproductive Toxicology, “oxybenzone is small enough to pass through skin and placenta barriers. Numerous studies have identified this chemical in the urine/blood of pregnant women. It’s also been identified in fetal and umbilical cord blood. A recent study demonstrated that women with medium to high levels of oxybenzone in their urine was associated with giving birth to neonates with Hirschsprung’s Disease (HSCR). Testing in human cell lines confirmed that low levels of oxybenzone has the potential to disrupt cell migration and function in a manner similar to what is associated with HSCR. Analysis of human exposure levels to oxybenzone from sunscreen use, under normal conditions, demonstrates that enough chemical can cross into the mother’s blood making it available to the fetus at high enough levels that can indeed inhibit migration of neural crest cells during critical embryonic development.”
So, if you do prefer using a chemical sunscreen during pregnancy, make sure it is one that doesn’t contain oxybenzone. And, be sure to get the green light from your doctor.