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 cannot use safely and effectively. Here is the summary:
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.
5. Salicyclic Acid (orally administered)
Salicyclic acid, which may be derived from the Salix alba plant 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 salicylic acid, and to avoid ingesting any supplements containing salicylic acid or BHA (beta hydroxy acid; salicylic 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
…What about retinoids (retinol, retinyl palmitate) in over-the-counter topical treatments?
A 1999 review by G. Reis and R. Hess concluded that the form of retinoids commonly used in cosmetic products should be safe for use during pregnancy and while nursing. This is due in part because of the topical, rather than oral, administration of the drug. Another reason is that retinol and retinyl palmitate have about one-twentieth the potency of tretinoin (Lupo). This is because retinol and retinyl palmitate must first be converted to retinaldehyde, and then all-trans retinoic acid, in order to be effective. Therefore, based on the literature, it seems that topical treatments with retinol and retinyl palmitate should be safe. However, if you feel safer and can do without your cosmetic products with retinol and retinyl palmitate for nine months, then please do so.
Vitamin D deficiencies in pregnant women have been associated with the development of multiple sclerosis in babies (Chaudhuri). In addition, prolonged exclusive breastfeeding without vitamin D supplementation is one of the most significant causes of the reemergence of rickets (NIH). A 2007 study from the University of Pittsburgh found that both black and white women in North America are “at high risk” for vitamin D insufficiencies, even when taking prenatal vitamins. Therefore, pregnant women should spend sunscreen-free time in the sun to acquire adequate levels of vitamin D, and consider taking a supplement as well. According to Dr. Michael Holick of Boston University, standing outside sunscreen-free between the hours of 10 A.M. and 4 P.M. for fifteen minutes a day three times a week lets the skin produce enough vitamin D for most of the year. (Expose your face, arms, hands, and back.) Since CNCA.com reports that pregnant women should get the same amount of vitamin D as non-pregnant women, 400 IU, spending fifteen minutes sunscreen-free three days a week should be enough. Interestingly, too much sun is unlikely to create an excess of vitamin D, but too much vitamin D via supplement can. Excessive vitamin D levels have been associated with nausea, vomiting, poor appetite, constipation, weakness, weight loss, and calcinosis, the deposition of calcium and phosphate in the body’s soft tissues such as the kidney. Therefore, when pregnant or nursing, try to spend more sunscreen-free time in the sun, and take a vitamin D supplement, but keep total vitamin D from food and supplements below 50 micrograms, or 2000 IU.