Skincare During Pregnancy: Scientific Facts
Updated: Jan 4
How to keep your skin looking good during pregnancy & while breastfeeding
This is a comprehensive blog; however, this is your baby we are talking about right? I am presenting scientific-based information (references are at bottom of the page).
In order to discuss which products are safe to use during pregnancy, you must understand how the FDA categorizes drugs/products for pregnancy as listed by the Department of Public Health and Human Services:
Category A: (safe) Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
Category B: (safe) Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.
Category C: (not safe) 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.
Category D: (not safe) There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Category X: (not safe) Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in the use of the drug in pregnant women clearly outweigh potential benefits.
According to the Mayo Clinic pregnancy due to hormonal fluctuations can lead to a number of changes in your skin. These include changes in pigment, acne, varicose veins, and stretch marks. Girlfriend, it’s easier to prevent these problems than to have me fix them later on. Unfortunately ladies you CANNOT get neuromodulators (botox/dysport/xeomin) or fillers during pregnancy. Reason why is that it hasn't been studied.
The area around your nipples, inner thighs, genitals, and neck might darken. You might notice a dark line from your navel to your pubic bone (linea nigra). The biggest concern for most involves the risk of chloasma/melasma which are dark patches on your face that may remain permanent. Avoid sun exposure, which can worsen chloasma/melasma. Since UV exposure can worsen melasma, sunscreen SPF 30 or higher that blocks UVA/UVB rays is a must. Choose physical sunscreens that contain titanium dioxide and zinc oxide. Avoid chemical sunscreens containing oxybenzone. I do not recommend any laser treatments or chemical peels during pregnancy. Preventing pigment problems with sunscreen is key!!!Bakuchiol may be an option to decrease pigment during pregnancy instead of retinol.
What is it?
Bakuchiol is an antioxidant that comes from seeds of the corylifolia plant, found mostly in India. Traditionally, it has been used for rashes, redness, and healing cuts, and more recently, it has started popping up in skincare products as an option for people who can’t use retinol and retinoids. Again, I always recommend checking the ingredients in your products on the Environmental Working Group (EWG) and with your medical provider.
Acne during pregnancy is a concern for many. To counter acne, wash with a gentle cleanser. Shampoo regularly, don't pick blemishes, and be careful about what touches your skin. Wear clean masks, change your pillow cases often, use mineral makeup (check ingredients) and don't share face products. Alpha Hydroxy Acid’s (AHA’s) including mandelic acid, lactic acid, and glycolic acid are deemed safe during pregnancy and nursing. They may be helpful in the treatment of acne and pigment concerns.
Mandelic acid is the largest alpha hydroxy acid, so it penetrates the skin slowly and doesn't cause irritation as much as the other AHA’s. Topical erythromycin a (category B) and sulfur are also considered pregnancy safe.
The American College of Obstetrics and Gynecology (ACOG) endorses glycolic and azelaic acid as safe to treat acne during pregnancy, in addition to topical benzoyl peroxide and topical low dose salicylic acid (a Beta Hydroxy Acid-BHA). Another product that works well in sensitive skin is Bakuchiol as noted above. Stay tuned for a separate blog discussing AHA's and BHA's (what are they and how are they helpful).
You might develop enlarged veins in your legs (varicose veins) due to your uterus exerting greater pressure on these veins. Hormonal changes during pregnancy also might play a role.
Varicose veins that develop during pregnancy generally improve without medical treatment three to 12 months after delivery.
Here are some tips to prevent these unsightly veins:
Avoid sitting/standing in same position for long periods of time.
Avoid wearing high heels. It is better to wear lower-heel or flat shoes as this works your calf muscles, fostering healthy circulation.
Get regular exercise. Talk with your doctor to confirm if it is safe for you to exercise during pregnancy.
Wear maternity support hosiery. These put pressure on the legs, stimulating blood flow up the leg towards the heart. However, avoid wearing tight hose that cut off circulation.
Avoid crossing your legs while sitting.
Elevate your legs periodically to improve circulation.
Sleep on your left side. This will help relieve pressure on the inferior vena cava.
Reduce sodium intake to minimize swelling of the veins.
Drink plenty of water and eat enough fiber to prevent constipation.
Stretch marks (striae) are indented streaks that often appear on the abdomen, breasts, hips, buttocks, and thighs. They're caused by the stretching of the skin and are common during the second and third trimesters. Many creams, ointments, and other products claim to prevent or treat stretch marks.
However, treatments are only partially effective and won't remove stretch marks completely. According to dermatologist Dr. Laura Cross tips to avoid stretch marks and dry skin include staying: hydrated and moisturized. Frequently moisturize your abdomen with products including hyaluronic acid (HA), peptides, coconut oil, vitamin E cocoa shea butter and peptides. Parents.org recommends: Bio-Oil Skincare Oil.
Tips to prevent stretch marks:
Control your weight (typically 25-35lb),
Eat a nutrient-rich diet.
Include vitamin C in your diet.
Soak up some vitamin D with sunscreen of course,
Eat foods rich in zinc.
Treat fresh stretch marks when they appear:
Mederma Stretch Marks Therapy is safe to use starting in the second trimester, and has been shown in clinical studies to significantly minimize scarring. Just keep in mind that you have to be diligent about applying it daily, and it may take up to a month to see an improvement. While you wait, camouflage the red with a product like Dermablend Leg and Body Cover SPF 15. It won't rub off on your clothes.
If stretch marks remain post-pregnancy when you are no longer breast feeding we may try a retinol to reduce the appearance of stretch marks (if you are not breast feeding). We may not be able to eradicate them, so it's best to try to prevent them!
What about other Skincare Products?
I often get asked what skincare products can safely be used when pregnant. Certain ingredients can be absorbed into your body, and therefore, your baby’s body, too.
I must point out that evidence-based data on the safety of specific products in pregnancy is limited as we don’t tend to test products on pregnant women or fetuses. This information is not medical advice and I always recommend you check with your medical provider regarding what is safe to use during pregnancy.
In addition to the products already discussed the ACOG also lists pregnancy-safe antioxidants to try in your skincare products to include vitamin C, E, K, B3, green tea, and Bakuchiol.
According to the Academy of Dermatology (AAD) products to be avoided during pregnancy include:
High dose salicylic acid (lower-dose topical OTC salicylic acid have been reported safe by ACOG)
Phthalates / Diethyl phthalate (DEP)
American Academy of Pediatrics discusses that Phthalates are endocrine-disrupting chemicals found in many beauty and personal products. In animal studies, serious reproductive and hormone dysfunction has been linked to phthalate exposure. They can play a role in negatively affecting congenital reproductive health. Cosmetics are the top source of phthalate exposure, and the most common phthalate you’ll find in beauty products is diethyl phthalate (DEP). Some antiperspirants have these ingredients also so read labels!
Many cosmetics include formaldehyde or formaldehyde-releasing chemicals with a similar potentially dangerous effect.
These include the following, as noted by the Environment Working Group (EWG):
Basic Skincare tips:
Dry skin is a huge problem during pregnancy. To prevent over drying, wash your face no more than twice a day using lukewarm water (not hot water) and a gentle cleanser. Use a moisturizer at least twice a day. The site www.romper.com gives a list of 24 pregnancy safe moisturizers. I like Cerave. I recommend you always check ingredients on EWG (listed below) and with your medical provider if you aren't sure.
According to Bozza et al (2011) dihydroxyacetone is a color additive that is found in self-tanning products to produce an artificial tan. When applied topically, systemic levels are minimal; therefore, typically considered safe during pregnancy
How to check if your skincare products are safe:
First, read the ingredient lists and avoid the products reviewed. Next, the Environment Working Group (EWG) is a site dedicated to protecting human health and the environment. There is a list of safe products on their website.
Finally, check with your OB/GYN and your dermatology provider before starting a routine. If you have more specific questions not addressed here contact me at firstname.lastname@example.org or DM me @skinesteemmedspa on IG.
Dr. Laura Cross dermatology