Pregnancy can be one of the most beautiful times of a woman’s life — blood volume will more than double (Clinical Hematology, 1985), resulting in that characteristic “glow.” But by that same token, pregnancy can also come with difficulties for the skin, including stretch marks, skin tags, melasma, hyperpigmentation, and even acne.
Thankfully, there is a plethora of scientific research out there determining what pregnant women can – and cannot — use safely and effectively. Here is the summary:
3 Products You Should Use Daily
Mineral-Based, Non-Micronized Sunscreen
Depending on your level of weight gain and nutritional status, your skin may be stretched more quickly and more thinly than ever before during pregnancy. As you can imagine, the stress on the skin increases hyperpigmentation rates (Journal of the European Academy of Dermatology and Venereology, 2007) and makes it more susceptible to UV damage in general. That’s why sunscreen is more important than ever.
Typically, for non-pregnant and nursing women, the best sunscreens are micronized zinc or titanium oxide. The reasons? First, oxides like zinc and titanium oxide prevent UV light from hitting the skin altogether. This is unlike chemical sunscreens, which allow for UV light to hit the skin, but then transform it into a non-damaging form of energy, like heat. I personally have found my skin is in better condition when I use physical sunscreens, but this may very well be a personal bias, since all sunscreens are measured on the same PA++++ scale (for UVA protection) and SPF scale (for UVB protection). Second, micronized oxide sunscreens generally leave the skin less white or chalky than non-micronized formulas.
However, I think the best sunscreens for pregnant and nursing women are non-micronized zinc and titanium oxide sunscreens. When UV light hits the skin, it has been suggested that metal oxides may produce oxygen free radicals and initiate deleterious events in the skin (Free Radical Biology and Medicine, 1997), but only when they are small enough to traverse the skin (Cosmetic Dermatology, 2002). Granted, don’t be too alarmed — most sunscreens won’t cause metal oxide-induced damage because most companies minimize the photoreactivity of metal oxides agents by coating the sunscreens with silicone or dimethicone (Photodermatology, Photoimmunology, and Photomedicine, 2003).
But if you are pregnant or nursing, I wouldn’t take the risk with micronized zinc or titanium oxide, which can have particle sizes as small as 0.2 micrometers or less. I would instead go with full-sized zinc or titanium oxide particles in sunscreens that are also coated with silicones, which lay atop the skin and protect the zinc or titanium oxide from UV-induced free radical production. My favorite of these is Shiseido Anessa Mild Sunscreen SPF 43 ($45.50, FutureDerm.com/shop), which is typically available only in Europe, Asia, and Australia, but I managed to source through a vendor (yay!) for my American/Canadian followers as well. This sunscreen has significant UVA/UVB protection, seems to have enough silicones to protect the skin from any oxidation of metal oxides, and does not feature micronization but still does not result in a white tint on the skin. Bravo!
Ingredients: Cyclomethicone, Water, Dimethicone, PEG-9 Polydimethylsiloxyethyl Dimethicone, Polysilicone-15, Alcohol, Ethylhexyl ethylhexanoate, Sorbitan sesquiisostearate, Xylitol, Dimethicone/Vinyl Dimethicone Crosspolymer, Aluminum hydroxide, Dextrin palmitate, Bis-butyldimethicone polyglyceryl-3, Trimethylsiloxysilicate, Methyl gluceth-10, Dipotassium Glycyrrhizate, Scutellaria Baicalensis Root Extract, Sodium Hyaluronate, Thymus Serpillum Extract, C9-15 Fluoroalcohol Phosphate, Potentilla Erecta Root Extract, Stearic Acid, Silica, Disteardimonium Hectorite, Hexyltrimethoxysilane, Cetyl Ethylhexanoate, Isostearic Acid, Trisodium EDTA, Butylene Glycol, Acrylates/Dimethicone Copolymer, Phenoxyethanol, Zinc Oxide, Titanium Dioxide, Iron Oxides
Camellia oil, also known as tea seed oil, is similar to olive oil and grape seed oil in its storage qualities and low concentration of saturated fat. For centuries, camellia oil has been used in cooking in China, a tradition that is likely to sit well with all-natural skin care enthusiasts who advocate to use only the skin care ingredients you would eat. I personally am not that strict, but I do appreciate a 2007 study in Ethnobiology, which found that camellia oil increases collagen production within the skin and promotes hydration.
Specifically, camellia oil was found in the aforementioned study to stimulate collagen production by two mechanisms: One, camellia oil activates a gene promoter in human skin cells (COL1A2), which starts the production of a specific type of collagen (collagen type 1). Two, camellia oil prevents the breakdown of collagen by inhibiting matrix metalloproteinase (MMP)-1, an enzyme that breaks down collagen. That’s pretty awesome.
Add in the fact that camellia oil-treated skin had less transepidermal water loss (TEWL) than non-treated skin 1-2 hours after treatment, and you’ve got yourself a quality product that may actually prevent stretch marks, which are caused by the breakage of collagen and elastin fibers. Amazing. My favorite? Elemis Camellia Oil ($38.95, Amazon.com) — use it all over, morning and night (twice daily) from the time you’re starting to try to get pregnant until you stop breast-feeding to prevent stretch marks and keep skin supple.
Mama Mio FutureProof Firming Active Body Butter
During pregnancy, glucocorticoid hormones are released, preventing the skin cells from producing new collagen and elastin fibers. This makes the skin less firm and more easily stretched. As the pliable skin continues to grow, this can induce tearing of the dermis (under the skin) or epidermis (upper layer of the skin). Interestingly enough, numerous creams have been shown in very reputable, peer-reviewed, double-blinded studies to prevent the formation of stretch marks. These include cocoa butter, as established by a 2010 study in The International Journal of Obstretics and Gynecology, and a combination of Centella asiatica extract, vitamin E, and, interestingly, collagen and elastin hydrolisates, as proven by a 1991 study in The International Journal of Cosmetic Science.
Cocoa butter is likely to have an effect because it is hydrating, and Centella asiatica extract has potent antioxidant activity that may aid in dermal wound healing, as suggested by research in the Indian Journal of Medicine.
Personally, if I were pregnant, I would use Elemis Camellia Oil followed by a shea butter and vitamin E- rich cream like Mama Mio FutureProof Firming Active Body Butter ($56.98, Amazon.com) twice daily to maximize collagen and elastin production, as well as to keep the skin supple.
Once You Stop Breast-Feeding, Resume to Normal Skin Care
Once you stop breast-feeding, resume to normal, full-strength skin care. As always, I recommend the “big 5″: retinoids, alpha hydroxy acids (not at the same time as retinoids), niacinamide, antioxidants, and sunscreen!
11 Ingredients to Avoid
1. Accutane (orally administered)
Accutane (isotretinoin) is a derivative of vitamin A commonly prescribed to patients with acne. Of all the ingredients and drugs listed here, Accutane is by far the worst. According to the Organization of Teratology Information Services (OTIS), women who take Accutane during the first twelve weeks of pregnancy risk severe birth defects. These include severe fetal brain and heart defects, mental retardation, and other birth abnormalities. The correlation is strong, with one in four babies exposed to Accutane drug during the first trimester of pregnancy experiencing severe side effects.
Fortunately, according to the New England Journal of Medicine, the percentage of Accutane users who are advised about potential birth defects is high: 99 percent of 177,216 women prescribed Accutane recalled being instructed to avoid pregnancy (New England Journal of Medicine, 1995).
Women who are taking Accutane and plan to become pregnant are advised by OTIS to stop using the product one month before trying to get pregnant, to be absolutely sure that the product is gone from the bloodstream.
2. Retin-A, Avita, Renova (topical treatments)
Retin-A, Avita, and Renova all contain tretinoin, like Accutane. All are topical treatments that are commonly prescribed to improve acne, hyperpigmentation, wrinkles, and skin texture. Each contains between 0.025-0.1% tretinoin and is applied to the skin, whereas Accutane is 10-40 mg of orally administered isotretinoin (USPharmacist.com). A 2002 study by Briggs et. al. cited here estimated that even if maximal absorption (about 33%) occurred from a daily application of 1 g of a 1% tretinoin preparation, a patient would receive only one-seventh of the vitamin A activity from a typical prenatal vitamin supplement. A further study by Lancet et. al. in 1993 affirmed this opinion, concluding that “topical tretinoin is not associated with an increased risk for major congenital disorders.” Still, despite the research otherwise, the Organization of Teratology Information Services (OTIS) says that is “a safe approach” for women to stop using Retin-A one month before trying to get pregnant.
3. Skin Care Supplements Containing Vitamin A (orally administered)
Yes, we’re still on the “A-train” here. (Or encouraging pregnant women to step off of it!) Skin care supplements often contain vitamin A. However, you may be putting your child at risk of vitamin A overdose, as a slightly higher instance of birth defects have been found in babies whose mothers consumed more than 10000 IU/day of vitamin A, and the average adult diet in the U.S. contains 7,000–8,000 IU/day of vitamin A without a supplement (Russell-Briefel et al., ’85). At least seven case reports of adverse pregnancy outcome associated with a daily intake of vitamin A of 25,000 IU or more have been published (Rosa et al., ’86). However, before you get too alarmed, keep in mind one study of nearly 300 women did not find a link between consumption of about 50000 IU/day vitamin A and birth defects.
So what is a pregnant woman to do? Her best option is to continue to consume a healthy diet and talk to her physician about recommended prenatal vitamins, which normally have vitamin A levels adjusted for dietary intake.
One further caveat: do not get overly cautious and over-limit vitamin A, as retinol deficiency during pregnancy has been associated with anemia and other health problems. If you are ultra-diligent and want to monitor your vitamin A intake, write down the foods and supplements you consume during a typical week, and ask a nutritionist for a formal assessment.
4. Sunscreens containing avobenzone or oxybenzone
Before I continue any farther, I want to state first that no studies have been shown that avobenzone or oxybenzone are very toxic. In fact, a 2005 study by Hayden et. al.demonstrated that the ingredients are not harmful when applied to the skin. However, avobenzone and oxybenzone (the latter present in 20-30% of sunscreens) have been demonstrated by Hayden et. al to be absorbed into the body and secreted into the urine of users. According to Dr. Leslie Baumann, director of Baumann Cosmetic Research Institute in Miami, “Oxybenzone has low acute toxicity in animal studies, yet little is known about its chronic toxicity and disposition after its topical application in people. For this reason, sunscreens containing this agent are not recommended for use in children.” And, again,although maximal absorption of a topical ingredient from the skin is about 33%, it is probably a safe approach to use sunscreens without avobenzone or oxybenzone during pregnancy or while nursing. A safe alternative is a sunscreen containing zinc oxide with its photoreactivity minimized by surface coating with dimethicone or silicone, such as Blue Lizard Australian Sunscreen, SPF 30 ($12.99, Drugstore.com).
5. Salicyclic Acid (orally administered)
Salicyclic acid, which may be derived from the Salix alba plant (shown above) may cause birth defects in high doses of the oral form (BabyCenter). However, small amounts applied to the skin — such as a salicylic acid-containing toner used once or twice a day — are considered safe, says Sandra Marchese Johnson, a dermatologist with Johnson Dermatology in Fort Smith, Arkansas. But the concern is stronger about face and body peels, which contain higher concentrations of salicylic acid. “This kind of ‘soaking’ in the ingredient is similar to taking one or more aspirin when pregnant,” she explains.
According to BabyCenter.com, your best bet is to consult your dermatologist about any products you are using containing salicyclic acid, and to avoid ingesting any supplements containing salicyclic acid or BHA (beta hydroxy acid; salicyclic acid is a BHA).
6. Soy that is not “active soy”, or oil of bergamot
Many women experience a darkening of the skin during pregnancy (“the mask of pregnancy”) that is caused by overactive melanin production. According to BabyCenter.com, soy-containing products and oil of bergamot have estrogenic effects, which can make this form of melasma (darkening of the skin) worse. However, products by Johnson & Johnson brands (i.e., Neutrogena, Aveeno, amongst others) contain a form of soy known as “active soy,” in which the estrogenic compounds have been extracted, so these should not exacerbate melasma like other products.
7-17. The following list of herbs
Herbs are an interesting breed in skin care: On the one hand, alternative medicine practitioners have long noted the effects of certain herbs, like St. John’s Wort for depression, or aloe vera for soothing the skin. On the other hand, we still don’t know how efficacious most of these herbs are in comparison to many ingredients or drugs used in western medicine. We also don’t fully understand all of the potential contraindications of every possible combination of herbs with western ingredients/drugs. With that said, despite the limited research on herbs, there are some the Natural Medicines Database and the American Pregnancy Association declare “Unsafe” or “Likely unsafe” during pregnancy:
- Saw Palmetto – when used orally, has hormonal activity
- Goldenseal - when used orally, may cross the placenta
- Dong Quai – when used orally, due to uterine stimulant and relaxant effects
- Ephedra - when used orally
- Yohimbe - when used orally
- Pay D’ Arco – when used orally in large doses; contraindicated
- Passion Flower - when used orally
- Black Cohosh – when used orally in pregnant women who are not at term
- Blue Cohosh – when used orally; uterine stimulant and can induce labor
- Roman Chamomile – when used orally in medicinal amounts
- Pennyroyal – when used orally or topically