"Pregnancy Safe" Skincare Spiral

The last thing I want a pregnant person to worry about is skincare.

Whenever I start researching pregnancy safe skincare, I end up in a spiral. Curating ingredients that are OK to use is straightforward, what’s more challenging is the simmering rage I feel on behalf of parents. It’s no secret the US can be hostile, judgmental, and deadly towards parents and their families. Maternal mortality is rising at an unprecedented clip in the United States, particularly for Black parents. Parenthood is a stress soup. I don’t want to add any additional seasoning.

Thankfully, the skincare rules when you’re pregnant are pretty simple, in the absence of information… don’t do it. Just like soft serve and rock melons are on the “no” or “be very careful” list, so are certain ingredients you slap on your face.

There isn’t much research out there (you can’t really test on pregnant people due to *ethics), so, the cautionary approach is taken. This is largely how brands are able to make claims. We’ll get into what that means, but first, what’s happening to your body when you’re pregnant?

Pregnancy is like another puberty.

Congratulations to all people whose hormones pop off during pregnancy, but, that may not be the case for everyone. As one journal found; a majority of women experience “significant and complex skin changes.”

This includes hormonal, immune and metabolic changes. All of which manifest in your skin based on genetics in addition to underlying skin conditions you may. Common changes?

• Pigment change. Estrogen can increase the output of melanin meaning things like your nipples can get darker but also; melasma along with scars deepening in tone etc.

• Hair is usually impacted with thickening and strengthening which then sheds for 6-16 weeks after pregnancy. While hair sheds within that timeframe, it can take a year for it to grow back. If your nails get brittle, don’t worry, that also can happen.

• Circulatory shifts. If you see what looks like broken capillaries crop up, again, normal!

What is the “cautionary approach?”

The theme with pregnancy safe skincare is better safe than sorry.

There are studies with topical retinoids, and the results are surprising in a good way. The study suggested there is not “an increased risk of retinoid embryopathy.” That being said, the authors go on to note that “topical retinoids cannot be advised for use during pregnancy because their risk/benefit ratio remains questionable.”

Translation; having supercharged collagen production in the name of esthetics isn’t a benefit that outweighs the potential risk to a fetus. We also know there is a definite risk with oral Vitamin A medications. So, the advice is, don’t do it!

What we also shouldn’t be doing? Demonizing retinol. Tis a safe ingredient, and the closest thing skincare has to a miracle. It’s so special, brands try to associate with it calling themselves “retinol alternatives.” A reminder there is no such thing, even if the ingredient on it’s own is lovely. The reality is, retinol is a gorgeous and perfectly safe ingredient, you’re just in ingredient lock down until you’re done breastfeeding.

Lastly, pregnancy is temporary. So, you can get back to your gold standard retinoid eventually.

So, if you can’t test on pregnant people, how do you know it’s pregnancy safe?

You don’t. Some ingredients absorb minimally into the skin and when that happens, pending the amount, they tend to be on the “you should probably wait until after your baby is out of your body” list.

To understand more about how & why with pregnancy safe skincare (along with common questions), I spoke with board certified dermatologist Dr. Joyce Park about how to navigate the claim pregnancy safe, what to look for and why avoiding stress (and any brand, person, influencer that triggers it) is important.

Q: So how do they know that skincare is pregnancy safe?

Dr. Joyce Park: There’s a real lack of data on ingredient safety in pregnancy because we cannot perform the gold standard of randomized controlled trials on pregnant people due to ethical reasons. Most of the data we have is from case control studies or case reports. AKA, observational studies.

For some skincare, it’s very clear what you can and can’t use. For example, OTC products making drug claims like Adapalene, Salicylic Acid and sunscreen require FDA approval. These products will clearly state with instructions how to use during pregnancy. As a reminder, retinoids are not cleared to use so you can’t use Adapalene during pregnancy.

Cosmetics on the other hand are like the wild Wild West. They don’t require FDA approval. Pregnancy safe is a term that the brands themselves can get additional testing to verify, but since we generally do not include pregnant people in trials, they mostly get around this issue by claiming safety solely based on the ingredients used. Some can also confer with a dermatologist team to get additional expert approval for pregnancy safety based off of ingredients. But in short there’s no official FDA approval for pregnancy safe. 

The FDA can after the fact conduct investigations into specific products if there is concern raised by consumer reports. 

Q: What should pregnant women look out for with supplements? Diet?

Dr. Joyce Park: Supplements are not regulated in the US which makes it that much harder to choose supplements! Since each patient has a unique medical history I think the best is to ask your doctor when considering supplements. For example: if you have thyroid disease and you’re pregnant, I wouldn’t advise taking high dose biotin supplements because that can interfere with thyroid screening blood tests. 

Diet wise, same advice, to confer with your doc. Everyone’s risk tolerance is different. One example: Women in Japan eat sushi all throughout pregnancy but in the US it isn’t recommended. Personally I was ok with eating raw fish from reputable restaurants that use high quality raw fish and I avoided fish with high mercury content while pregnant. But again, check with your doctor to make a personalized plan for you. 

Q: Why the fear around chemical sunscreen?

Dr. Joyce Park: A lot of the chemical sunscreen filters available in the US have been linked to various health claims, and a lot of that is simply fearmongering. Many of these claims are extrapolated from animal studies where exposure to the chemical filters was hundreds of times higher than what we would get through topical use ie rats were fed high oral doses of ingredients. I actually tackled oxybenzone and a few other ingredients in a blogpost here.

Then in 2020 a paper came out in JAMA that showed systemic absorption of sunscreen filters at levels above the FDA threshold for waiving further investigation. I stress to patients that this study did not show that the levels found were toxic though, just that more studies are warranted. We do not have any data that shows that topical use of spf causes harm. 

A review article looking at safety of oxybenzone and octinoxate also found conflicting info but the bottom line: no definitive evidence establishing a causal relationship between these SPF ingredients and systemic harm.

My advice to patients is if they are concerned about any systemic absorption, and if stressing about this makes them not want to wear sunscreen, they can just choose to use mineral sunscreens. And if they hate all sunscreens for some reason then wear UPF clothing, cover up with a hat and sunglasses and seek shade during peak sun hours. 

Q: What about babies? Chemical sunscreens are used a lot in formulas in Europe but there is fear in the USA?

The main concern with babies is they have higher systemic absorption of topical ingredients than adults and their skin can be more sensitive and prone to irritation from chemicals. The recommendation of the AAD on this is that for infants younger than 6 months, use sun protective clothing and seek shade. But if you need some SPF in babies younger than 6 months you can still use zinc oxide or titanium dioxide sunscreen on their exposed areas! Zinc oxide is the SAME ingredient as in diaper paste and we use that all the time on babies! For babies over 6 months you can use any sunscreen SPF 30+, water resistant, and broad spectrum. If your baby like mine has eczema or sensitive skin then choose mineral based sunscreens which will be less likely to cause irritation. I don’t like the marketing language that calls some sunscreens toxic (chemical filters) vs non-toxic (mineral based) because these ingredients are not toxic…

Q: What are your favorite pregnancy safe skincare ingredients?

• Azelaic acid - multitasker with anti inflammatory and brightening properties that we use for acne rosacea and hyperpigmentation in pregnancy

• Vitamin c - amazing antioxidant and brightener

Q: Is there any advice you have for pregnant women? What advice do you have for women who are stressed out about skincare and pregnancy?

Dr. Joyce Park: Pregnancy is already a stressful time, and worrying about skincare can add on additional stress! If at all concerned my recommendation is to speak with a dermatologist and have them curate a pregnancy safe routine for you. I actually have had several patients in the last month make appointments with me to change their routine to a pregnancy safe one! 

Thank you Dr. Joyce Park for helping answer questions! Follow her here.

A reminder that if you don’t have access to a dermatologist and have to turn to the internet, please use blogs and resources that are vetted by toxicologists and dermatologists. Be VERY wary of advice that uses fear to get you to buy something, tis a red flag.

My favorite skincare product or ingredient isn’t covered here?!

Here’s is a handy chart of ingredients are “pregnancy safe.”

What products do you recommend??

This is a more loaded question as there are SO many wonderful brands out there. I compiled a small list of some of my favorites (affiliate) here.

Any questions? Leave them in the comments (open to all users).