Many women understandably want to carry on with their skincare and aesthetic treatment plans whilst pregnant or breastfeeding. However, due to lack of evidence and research in this area the current guidance is to advise patients to stop. This article explores the reasons behind the guidelines and what regimes you can recommend to pre and postnatal mothers.
Skin changes during pregnancy
Hormonal acne, skin sensitivity, dry skin, rosacea, and melasma (often called the ‘mask of pregnancy’) are all skin conditions pregnant women can experience due to a shift in hormones and an increase in blood volume which occur to protect and grow the foetus. According to one study of 124 women, 91.1% of pregnant women had abnormalities in the skin during their gestational period.1
It is in general agreement that no beauty, skincare, or aesthetic remedies are to be performed in prenatal or breastfeeding women, and that patients should stop these practices whilst trying to conceive. However, dermatologists and aesthetic doctors with special interest in perinatal treatments may recommend plans in severe cases (this particularly applies to acne prevention). The information about what skincare is and isn’t safe to use whilst pregnant (or breastfeeding) is currently confusing, not only for patients but for health professionals working in the field too. Understandably, because of concerns over safety for the foetus and the impact skincare ingredients (such as retinoids) may have on the baby once born, there has been little research into side effects of perinatal skincare routines. The only information available comes from animal studies.2
Ingredients to avoid
The ingredients found in skincare products that have been highlighted as a risk to expectant mothers, and therefore should be avoided in practice, are:
Hydroquinone
An organic compound (a type of phenol) that is used for whitening and brightening skin. Whilst the ingredient won’t harm the foetus, it can cause harm and reactions to the skin of a woman which becomes more sensitive when pregnant and breastfeeding.3
Retinoids
Also known as retinoic acid or vitamin A acid, and other topical retinoids like tretinoin, tazarotene, adapalene and oral isotretinoin, are often used to alleviate serious acne breakouts. These are completely off-limits when pregnant and breastfeeding as they can be absorbed through the skin and into breast milk and make their way into the mother’s and baby’s bloodstream.4 Studies have shown that an excess of vitamin A can affect embryonic development and result in teratogenesis, or the product of birth defects in a developing embryo.5 Malformations can occur to the skull, face, limbs, eyes and central nervous system of a foetus. Other risks are miscarriage and premature delivery.4
Doxycycline
An antibiotic used to treat skin infections and rosacea, it is listed in pregnancy category D by the US Food and Drug Administration (FDA). This means there’s positive evidence of human foetal risk based on adverse reaction data from investigational or marketing experience or studies in humans.6 There is currently no controlled data in human pregnancy, however population-based data from the Hungarian Case-Control Surveillance of Congenital Abnormalities revealed that of 18,515 women who had infants with congenital abnormalities, 0.3% were treated with this drug, showing a marginally statistically significant association with malformations and use of doxycycline anytime during pregnancy.7
Benzoyl peroxide
Is an antiseptic that reduces bacteria on the surface of the skin and is used to treat acne. Some practitioners say it’s safe to use in small doses, however as there is no scientific evidence to prove this information, the general recommendation is best to avoid it until after gestation.6 The imposed risks will however be less for breastfeeding mothers, as long as the ingredient is not used on the chest area and doesn’t come into contact with the baby.7
Oxybenzone
An organic compound that’s used as a chemical filter in sunscreens to slow the absorption of harmful UVA and UVB rays by human skin. The US FDA is currently researching the possibilities of the compound being a carcinogen and endocrine disruptor, which has also been linked to Hirschsprung’s Disease, a birth defect that can be life-threatening.8
Formaldehyde
A pungent-smelling colourless gas that can be used as a preservative in cosmetic products. Exposure to the compound has been proven to increase risks of defects ranging from birth malformations to spontaneous abortions.9
Spironolactone
A medication that contains anti-androgen activity and is used to treat acne. Because of the anti-androgenic properties preventing androgens like testosterone and dihydrotestosterone (DHT) from mediating their biological effects on the body, there’s a potential risk of defects to a male foetus, which requires a certain level of testosterone to develop properly.10,11
Ingredients for desired results
Despite the many skincare treatments and ingredients that should be avoided in pregnancy, there are plenty of other regimes and remedies that can be provided in practice and produce desired results. Ingredients widely used in topical formulations that are deemed to be safe for perinatal women are:
- Hyaluronic acid: used for antiageing and hydrating skin. This ingredient is naturally found in our bodies and works well for all skin types.12
- Mild concentration of vitamin C: can help patients with melasma. It is recommended to apply sunscreen on top of the vitamin C serum.13
- Some polyhydroxy acids (PHAs): such as succinic acid, salicylic acid and gluconolactone are ideal for exfoliation and hydration. PHAs function similarly to other natural chemical exfoliants without irritation responses. PHAs large molecule size means they exfoliate at surface level and don’t penetrate skin too deeply, resulting in PHAs being a gentler alternative to alpha-hydroxy acids (AHAs) and beta hydroxy acids (BHAs).14
It’s advised to make patients aware that everything they use on their skin during pregnancy has the potential to cross into the placenta and developing foetus. Therefore, whilst there are skincare ingredients that are safe for perinatal patients, it’s important they follow their consultant’s advice of how much and how often they use skincare products to ensure they are not overused.
Recommendations
Taking into account safe and non-safe ingredients perinatal women can use in their skincare routines, here are my recommendations health professionals can give patients.
Hormonal acne
Acne during pregnancy is most common during the first and second trimesters.14 An increase in hormones (androgens) can cause glands to grow and produce more sebum. Sebum (an oily substance) clogs pores and may lead to bacteria, inflammation and breakouts. Many effective acne treatments use ingredients, such as retinoids, that pose high risks to pregnant women. This is why antibiotic treatments are commonly used for prenatal patients with severe acne, however it’s advised to stop this treatment by week 15 of pregnancy.14
In my view, one of the safest forms of treatment for acne is using a gentle gel-based face cleanser morning and night, but patients should avoid over washing and double-cleansing as I’ve found the skin can be more sensitive whilst pregnant. The cleansing regime should be followed by an oil-free moisturiser which helps keep skin clear and prevents it producing too much oil.
Diet can also affect hormones which in turn can make acne worse. Foods with a high sugar content spark a rise in insulin levels, causing oil glands to produce more oil, increasing the chances of acne. Practitioners should advise their patients to eat nutritious foods and drink plenty of water, to ensure insulin levels remain stable.15
Rosacea
Treatment for rosacea during pregnancy presents a significant challenge as many effective treatments are contraindicated or have limited evidence regarding adverse foetal effects. Light-based therapies with low-fluence lasers have been shown to have positive results. A study reported a case of safe laser therapy to treat severe acne in a woman at six weeks gestation. One patient was treated with 10 weekly sessions of low-fluence, 1,064 nm Nd:YAG laser using 400 to 800 pulses per session. In this case there was complete clearance of active inflammatory lesions and no reported pregnancy-related complications.16 However, it must be noted that it is not advised to try new treatments in prenatal.
Melasma
Between 50-70% of women will develop some form of melasma during pregnancy.17 As treatments for ‘the mask of pregnancy’ use ingredients thought to be unsafe, some experts recommend prevention rather than cure. Melasma is a cosmetic condition and does not affect the baby or mother in any way, and the most effective, and safest, remedies include avoiding direct sunlight exposure and using a pregnancy safe 30+ sunscreen, as the sun may trigger further development of more pigment. Pregnancy safe sunscreens have mineral based ingredients like zinc oxide and titanium dioxide. These ingredients sit on the surface of the skin and act as a physical barrier against the sun’s rays.14 You should only address melasma after breastfeeding has stopped.
Stretch marks
Stretch marks are a common concern for pregnant women and vary in quantity and severity, frequently affecting the abdomen, breast, and thighs. A study of 773 women, published in BMC Pregnancy and Childbirth, found 78.2% of prenatal respondents used a product to prevent or reduce the development of stretch marks during their pregnancy.18 Unfortunately, the study was unable to find high-quality evidence on the effectiveness of stretch mark products being used, such as mineral oil, cocoa butter and olive oil. Recommended advice includes trying to control rapid weight gain as stretch marks appear when the dermis becomes stretched and broken in places.19 Although, it’s important to note that perinatal women should not diet to lose weight whilst pregnant and should focus on having a healthy and balanced diet.20
Keep your patients safe
Research into skincare side effects for perinatal mothers is an extremely under-resourced area. To date, there is very little scientific evidence and health professionals more than often play it safe by advising against all types of treatments. Until more research has been conducted in this area, practitioners can simply continue to go by general guidelines and recommendations based on past experience. The new, innovative approach to skincare is seeing practitioners recommending a personalised skincare blend to meet a patient’s individual needs. In the case of perinatal skincare this avoids all confusion and simplifies treatment in a safe and effective way. In essence, you should check every ingredient on every product prescribed or recommended to ensure there are no substances, especially hidden ones, that can cause harm to mothers-to-be and their babies.
