I was pregnant for most of last year—I can’t believe my baby is nine months old now!—and although I’ve been a beauty editor for more than a decade, I still found myself googling and texting my derm friends about skin-care ingredients I could and couldn’t use during those nine-plus months. I also found myself disappointed when I asked my OB-GYN about certain ingredients I should avoid to get her expert insight and she told me I should 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.
“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 risk 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.
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 to avoid retinol and retinoids is out of an abundance of caution because of the effects of other vitamin A derivatives and oral acne medication Accutane on a fetus, which have been proven.
“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 retinal 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, and how long prior to pregnancy they need to discontinue using the ingredient to ensure they are not at risk. Defects associated with the product interaction include growth and development delays and eye, ear and head abnormalities, as well as fluid on the brain.”
On the other hand, when retinol is used topically, some dermatologists don’t think there’s cause for concern, but the community-wide consensus is to err on the side of caution. “Retinol is one ingredient that most dermatologists would say to avoid, mostly because of the connection between it and oral isotretinoin, aka Accutane,” says New York dermatologist Doris Day, MD. “However, retinol is a vitamin A, and when applied to a small surface area like the face, there is likely very little absorption, and much less than what we take in neonatal supplements and foods. Over-the-counter retinol products used on the face are generally considered to be safe during pregnancy. I think of it more as a medico-legal issue rather than a true medical risk to the fetus.” Nowadays, there are many safe ingredients with retinol-like effects that can be swapped into a routine instead, such as bakuchiol, rambutan and rosehip oil.
Tazarotene, which is a retinoid used for treating acne and psoriasis, should also be avoided, 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.”
“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. “Using it in concentrations over 2 percent should be avoided in pregnancy, and I would also avoid chemical peels with this ingredient because they are higher-concentration and used over a large area of the body. But, it is considered safe when in a cleanser at a concentration of 0.5 to 2 percent, or as a spot-treatment.” Hydrocolloid pimple patches can work wonders on spots as well, and are perfectly safe to use during pregnancy and breastfeeding.
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.”
According to a Canadian study on the safety of skin-care products during pregnancy, “when benzoyl peroxide is applied topically, only 5 percent is absorbed through the skin, and 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 and therefore use of this product during pregnancy would not be of concern.”
One of the most effective, yet controversial, skin-lighteners, particularly for melasma and other forms of stubborn hyperpigmentation, hydroquinone 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 U.S. as a result of the CARES Act (the Coronavirus Aid, Relief, and Economic Security Act), and any such products now require an FDA approved new drug application before they can be legally marketed. 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 or other adverse effects. However, because of substantial absorption compared with other products, it is best to minimize exposure until further studies can confirm safety.”
Though formaldehyde has been removed from most of the nail polishes on the market today, if you get your hands on an unknown brand of nail polish, give the ingredient list a once-over before your mani. Nail hardeners, nail polish removers, some keratin hair treatments and eyelash glue may also contain formaldehyde or formaldehyde releasers, such as quaternium 15, DMDM hydantoin and methylene glycol. “Exposure to formaldehyde has been linked to higher risk of congenital anomalies, lower than normal birth weights and premature birth,” says Dr. Shamban.
This is another controversial ingredient when it comes to what’s safe to use during pregnancy, as dermatologists tend to disagree. Some doctors, including Dr. Shamban, are of the mindset that chemical sunscreens—active ingredients include avobenzone, homosalate, octisalate, and octocrylene (no oxybenzone or octinoxate)—is that “it’s fine to use because there’s minuscule risk of systemic adaption.” 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, as well as 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 and your doctor(s) gives you the green light, make sure it is one that doesn’t contain oxybenzone, though most brands have reformulated their sunscreens without the ingredient in recent years.
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