Pregnancy can be an exciting, and slightly terrifying time, even for those who have given birth before. With all the things you’ll be planning and thinking about, one thing you don’t want to worry about is potential issues in your skincare routine. Hormonal changes can cause all sorts of skin issues, ranging from acne to dry skin to changes in pigmentation (melasma) to itching. Some of you will also notice increased skin sensitivity with pregnancy.
In this post we’ll address some of the most common questions around skincare in pregnancy. A theme we will keep returning to is “less is more”. A simple, effective routine can help you feel good about yourself without irritating your skin or elevating your stress level with too many steps. Cutting back might even help you grab a few extra minutes of precious sleep!
One great resource that doctors often refer to is the American College of Obstetricians and Gynecologists’ patient education website. And when in doubt, always ask your obstetrician!
Women of childbearing age (like us!) are often also using products to prevent signs of aging like wrinkling and sunspots. There are a few important things to know about anti-aging skincare and pregnancy. It might be frustrating to hear that doctors recommend stopping some of your favorite treatments and products, but remember that this is temporary and you can resume after your bundle of joy arrives!
Botox and fillers: Save your pennies for after the baby arrives—these are never recommended in pregnancy.
Topical retinoids: Studies have shown mixed results with most showing no clear evidence of harm when used during pregnancy. However, the risk/benefit ratio is still unclear, so as with acne products, retinoids and retinols (which help slow down collagen breakdown and increase skin renewal) are not recommended during pregnancy.
Hydroquinone : Used in lightening creams, there is no evidence for safe use in pregnancy, especially as there is some evidence that some amounts are absorbed into the body with regular use.
Minoxidil : Used in products designed to treat hair loss, this may be absorbed systemically with unknown consequences. We recommend you enjoy the thick, shiny hair many women notice when pregnant.
Hyaluronic acid An antiaging powerhouse moisturizer, this is often found in cleansers and serums and is great for before, during, and after pregnancy.
AHA/BHAs - alpha and beta hydroxy acids like salicylic acid, glycolic acid: These are safe when used in low concentrations and amounts and can help with acne (see below) as well as helping your skin with a quick, brightening pick-me-up.
Vitamin C: The sunshine vitamin! We did a deep dive into this ingredient here. It can act as a brightener and antioxidant for your skin.
Vitamin E: another antioxidant that’s found naturally in your own skin.
Azelaic acid: an ingredient that can help reduce development of skin darkening and pigmentation by blocking tyrosinase, it’s used for acne as well as brightening.
Kojic acid: another brightening, lightening agent that may also fight bacterial growth on the skin.
A special note about sunscreen
The foundation of any effective anti-aging routine is sunscreen. There are endless papers and debates about chemical versus physical sunscreens, which we also address in our post about sunscreens. Aside from that, a few thoughts: several studies have shown clearly that chemical sunscreen ingredients (oxybenzone, avobenzone, among others) are absorbed into the bloodstream with frequent use. While the jury is out on whether these chemicals are truly harmful to human health, many folks choose to use mineral based sunscreens with zinc oxide or titanium dioxide during pregnancy. There are many options on the market in all price ranges. Sun-protective clothing is also very effective.
But before you toss your entire cabinet of chemical sunscreens: remember that chemical sunscreen ingredients are so ubiquitous they’ve been found in drinking water, one study showed that over 95% of US adults had detectable oxybenzone in their bodies. Put another way, it’s likely you’ve already been exposed and probably already have a bit of this chemical in your system. This obviously isn’t ideal, but it’s also completely out of your control. If you just can’t find a mineral sunblock to your liking, try using your favorite regular sunscreen to smaller areas like the face and neck, and using mineral sunblock elsewhere or covering up other areas with hats and UPF clothing to lower overall exposure.
Pregnancy hormones can cause darkening and changing of some moles and sunspots (If you do notice a changing mole, a visit to your dermatologist is always a great idea.) Some people develop melasma, or “mask of pregnancy”, which can show up as darkening over the cheeks, forehead and sometimes even the upper lip. While annoying, this is usually temporary and most improve once the baby arrives. During pregnancy, most dermatologists recommend a simple skincare regimen including a mineral sunblock layered under a foundation or tinted moisturizer. After pregnancy, your dermatologist can work with you to develop a treatment regimen. In the meantime you can try azelaic acid serums or gentle face washes with low strength glycolic or salicylic acid, but the key is sunblock and remembering for many people this will improve fairly quickly.
With the rush of hormones in pregnancy, some women notice acne improves, and others notice a flare; even women who have never dealt with acne before may develop new breakouts. Fortunately, if you’re battling acne breakouts during pregnancy, you have several options to consider.
First, a few no-go ingredients in pregnancy:
Retinoids and retinols: These vitamin A derivatives work by increasing cell turnover and reducing clogged pores, but also affect cell maturation. Oral retinoids (isotretinoin) are never recommended in pregnancy as these can potentially cause severe birth defects. Regarding topical retinoids/retinols, a few early studies suggested that babies exposed to topical retinoids were at increased risk of birth defects, however, larger studies since then have not shown increased risk. While absorption into the body is likely minimal, doctors generally do not recommend usage during pregnancy
because of an unclear risk/benefit ratio
Hormonal therapies: some medications that block or alter specific hormones can be helpful for adult acne, but these are not used in pregnancy due to risk of birth defects.
Antibiotics: used short-term, an effective acne treatment. In pregnancy, certain classes like tetracyclines are avoided as they can cause bone and teeth issues. In severe cases of acne in pregnancy, dermatologists may consider certain antibiotics to prevent scarring. If this applies to you, talk to your doctor.
Now, onto the much longer list of anti-acne ingredients that are safe for use in pregnancy:
If you find yourself looking in the mirror and bemoaning the appearance of pimples, here are the products and ingredients you should look for. Many are over the counter and fairly affordable, and if these don’t work, a visit to your dermatologist will help.
Benzoyl peroxide: the tried-and-true- acne wash and spot treatment with an antibacterial effect is safe for use (just use a white towel!)
Topical salicylic and glycolic acids (part of a class of ingredients called AHA/BHAs): safe in pregnancy when used topically at low doses. Note that some of the at-home peels on the market contain high concentrations of salicylic acid; these are not recommended during pregnancy due to potential systemic absorption.
Azelaic acid: a brightening agent that is also anti-inflammatory and anti-acne, this is safe in pregnancy. This can be found in prescription and OTC forms.
Topical clindamycin: a prescription topical antibiotic that works especially well when used with benzoyl peroxide.
Topical erythromycin: another prescription topical antibiotic sometimes used for acne.
Topical metronidazole: A prescription anti-inflammatory medication used for acne and rosacea
Ingredients with limited evidence but likely safe:
Niacinamide: Niacinamide is a form of vitamin B, so it is unlikely to pose any issues in pregnancy.
Sulfur: There is no great evidence regarding sulfur safety in pregnancy, however, probably compatible according to InfantRisk. It’s worth noting topical sulfurs sometimes are used for non-acne related conditions in pregnancy.
Again, simple, gentle skincare can go a long way for sensitive skin during pregnancy. We especially like non-fragranced products since fragranced products can be irritating. Dry skin can be a common annoyance, and a good, fragrance free moisturizer can be a lifesaver for itching in pregnancy. If moisturizer just isn’t cutting it and you are still experiencing itchiness, talk to your doctor about prescription options. If you are itching to the point you cannot sleep, or are developing odd rashes, please also visit your doctor - there are some uncommon pregnancy rashes that deserve a professional evaluation.
Your expanding belly makes you and those around you smile, but you might be worried about developing stretch marks - or you may have already noticed those red shiny lines on your skin. Stretch marks occur when the skin is stretched quickly and the underlying collagen fibers, the support structure of the skin, are overstretched. Unfortunately, family history and genetics plays a large role in determining whether you are likely to get them. If you gain pregnancy weight quickly, are carrying a larger baby, or have an underlying medical condition, you may also be at slightly higher risk. Many companies would have you believe their special moisturizer or oil will help prevent stretch marks, but topical medications or ingredients on the market today generally lack strong evidence from well-run trials (Centella asiatica was found to be helpful in one small study, but tellingly, this study was done several years ago; if it was a game-changer, more products would likely contain it!). Most doctors instead recommend regular use of a thick, simple, fragrance-free moisturizer. If you are lucky enough to develop these badges of honor and find them bothersome, your dermatologist can help you come up with a plan to treat and minimize the appearance of these scars after your pregnancy.
We hope these tips help you feel better about your skincare routine in pregnancy. We recommend simple, gentle products that are effective and safe for all life stages. Emdash Clear Reveal, Vivid Protect, and Bright-CE serums, are packed with ingredients that help fight dark spots and even acne with gentle, non-irritating, fragrance-free, clean formulas. As a bonus, they are safe for pregnant and breastfeeding mamas as well (though again, if you have questions, please check with your OB). In a future blog post, we’ll walk you through a simple pregnancy skincare routine that will keep your skin glowing.
Disclaimer: As with all our posts, this blog is meant to be for informational and educational purposes, and is not medical advice. When in doubt, please ask your physician.
Murase et al, JAAD 2014