Skincare: Do’s and Don'ts in Pregnancy and Lactation
When a woman gets pregnant, there are a lot of questions that arise. One of those questions is, which skincare products are safe and which should be avoided?
In this blog, products and procedures that should be avoided due to possible or known detrimental effects to the fetus will be addressed. Certain ingredients in skincare products are easily absorbed and can reach the bloodstream of the mother and eventually reach the placenta and therefore the fetus. Products that are labeled as safe to use in pregnancy will also be noted.
Unfortunately, it is important to note that we are unable to find extensive data on various products and aesthetics procedures due to ethical issues, in terms of exposing pregnant women to ingredients or procedures that can affect their pregnancies in any way or form.
Products to avoid
Creams/ cosmetics containing vitamin A or any of the retinoids
For example, one of the most common ingredients in anti-aging products is Retinol which is just one of various types of retinoids. Retinoids is the umbrella term that is used to describe various types of vitamin A derivatives. It is important to be aware when purchasing skin care products that may contain any type of retinoids. When purchasing skin products during pregnancies a few other names to be aware of are the following:
Retinyl palmitate, which is known to be the weakest of the retinoids.
Retinol which is thought to be the next strongest and one of the most commonly used.
Retinaldehyde which is stronger than retinol
adapalene which is the strongest over the counter retinoid.
Prescription tretinoin ( vitamin A) or tazarotene.
The use of retinoids is still controversial, while there is a study that showed that endogenous vitamin A levels remained unchanged after repeated applications of 0.05% tretinoin the amount of drug absorbed through the skin was very minimal, in literature there are also 4 published case reports that convey retinoid embryopathy from the use of topical tretinoin. Until further data is reported, pregnant women should be encouraged to avoid the use of retinoids during pregnancy and while nursing.
Hydroquinone
Hydroquinone is an active ingredient that is used clinically as a topical depigmenting agent for conditions such as chloasma, freckles, lentigo and melasma. It is also used as a skin-whitening agent in many skin care products. Studies have estimated that around 35% to 45% is systemically absorbed following topical use in humans. One study has been published involving the use of hydroquinone during pregnancy and showed no adverse effects, however, the sample size of pregnant women was small. Since hydroquinone has a higher absorption rate in comparison to other ingredients used in cosmetics, it has a higher chance of reaching the placenta and therefore the fetus. The Food Drug Association (FDA) has designated Hydroquinone a pregnancy category C substance, which states that reproductive studies done on animals have shown to have adverse side effects on the fetus. But, there is a lack of well controlled studies in the human population. Taking all of the current data into consideration, it is best to avoid hydroquinone use all together in pregnancy and nursing until we have more concise data.
Salicylic acid (BHA)
Salicylic acid (BHA) has been used topically in various products for treating acne. One of the main skin concerns for pregnant women is acne, especially during the first and second trimester. Many pregnant women tend to run to buy products that can help them reduce the amount of breakouts. However, similarly to hydroquinone, salicylic acid is classified as pregnancy category C as per the FDA guidelines. Low concentrations and when used in smaller amounts (2% or lower) are thought to be safe in pregnancy however, some dermatologists and obstetricians will suggest to stay away from salicylic acids and use safer products instead.
Sunscreen
Pregnant women can become more sensitive to the sun. It is imperative to be aware of what the research currently reveals on the safety of physical and chemical sunscreens. Chemical sunscreens work by modifying UV rays with the end result of turning them into heat and then releasing the created heat from the skin. Ingredients used in these sunscreens, which pregnant women need to be careful with are oxybenzone, octinoxate, octisalate and avobenzone. Mineral sunscreens which are known as physical sunscreens, use active mineral ingredients like zinc oxide and titanium oxide. These ingredients end up staying on the surface of the skin and deflect the UV rays away. A recent study demonstrated that women with medium to high levels of oxybenzone in their urine were associated with giving birth to neonates with Hirschsprung’s Disease (HSCR). This same study showed that exposure to oxybenzone from sunscreen use can have enough of the chemical to cross into the mother's blood stream and therefore making it available to the fetus through the placenta. There are other studies that show that even after giving birth, it’s best to avoid chemical sunscreens since traces of oxybenzone have been noticed in breast milk. Due to the available data many obstetricians and dermatologists would suggest sticking to a mineral based sunscreen instead of a chemical based sunscreen.
Self tanner
Dihydroxyacetone (DHA) which is the main component in self tanner lotions, is the only active ingredient currently approved by the US Food and Drug Administration (FDA) for sunless tanning. Most self tanners have a concentration of 1% to 15% of DHA. Studies have shown that at these concentrations only about 0.5% will be systemically available. There is no consensus in the medical community on whether it is safe to recommend the use of self tanners or not during pregnancy due to the lack of data. Some would suggest that if possible stay away from any extra chemicals. If you are going to use a self tanner, it is best to use the lotions or creams. Precaution is suggested when using spray tans due to unknown effects of inhaling these chemicals.
Procedure
Botox
In pregnancy, the current data in terms of the administration of botulinum toxin type A ( (BTX-A) states that with proper administration of this toxin it is unlikely that it would be present in the systemic circulation at levels high enough to reach the placenta and affect the fetus. However, it is important to note that there is not sufficient data to fully determine the safeness of using this procedure during pregnancy or lactation.
Fillers
Like botulinum toxin type A, there is little safety data on the use of dermal fillers during and after pregnancy. In correspondence to the lack of data similar to Botox, there is no definite recommendation in terms of the use of fillers in pregnancy at this point. Many practitioners opt to stay away from recommending the use of fillers during nursing and pregnancy. Some also warn those that do proceed to use fillers, that due to the changes in weight and hormones the look of the fillers will change as the pregnancy progresses.
Chemical peels
In terms of facial peels, the most commonly used active ingredients are glycolic acid, lactic acid, salicylic acid and trichloroacetic acid. Currently, there is an absence of safety data in terms of the use of this procedure in pregnancy. As mentioned above under salycilic acid, salicylic acid is classified as pregnancy category C as per the FDA guidelines and it is best to be avoided during pregnancy. In terms of the use of glycolic acid ( 30%-70%) and lactic acid (2%), these two active ingredients are thought to be safe in pregnancy and lactation since the amount that it's absorbed through the dermal layer is so minute.
Safe Alternatives
Acne
Azelaic acid
For the treatment of acne, one active ingredient that can help with acne flare ups during pregnancy and it is labeled as safe is azelaic acid. Azelaic acid is an antimicrobial, antibacterial and anti-inflammatory. This acid can be used for other skin conditions as well that can be exacerbated during pregnancy, like rosacea and hyperpigmentation. Azelaic acid can be prescribed by your general practitioner under the name fincacea, or can also be bought over the counter.
Mandelic acid
Mandelic acid, an alpha hydroxy acid (AHA), can be used safely in pregnancy to help with acne breakouts and hyperpigmentation. This acid helps to increase cell turnover and penetrates into the skin slowly making suitable for sensitive skin. It also works to brighten the skin, keep it clear from breakout and helps maintain a healthy glow during pregnancy.
Laser Treatments
The available research indicates that laser treatments are safe to be perform during pregnancy for the use in acne, hyperpigmentation and anti-aging. It is recommended to wait until the second trimester prior to performing any laser treatments. Always consult a certified health professional for your treatments.
Chemical Peels
As mentioned above with respect to chemical peels, glycolic and lactic acid peels are deemed safe. To the contrary, trichloracetic and salicylic acid peels should be avoided or used with caution (reasons stated above under products to avoid during pregnancy). You can also find over the counter topical lactic acid and glycolic acid.
Hyperpigmentation
“The pregnancy mask” formerly known as melasma, is one of the most common skin concerns in pregnancy. Melasma in preganacy, is caused by changes in hormones especially estrogen, which stimulates melanin production during pregnancy.
Aside from the products and treatments mentioned above (Azelaic acid,mandelic acid, chemical peels and laser treatments) another holy grail for dealing with hyperpigmentation during pregnancy is Vitamin C. Vitamin C helps to brighten the skin , works as an antioxidant and stimulates collagen production. Meaning, it will help with hyperpigmentation and anti-aging.
Anti-aging
Prior to becoming pregnant, most women have an anti-aging routine that they follow religiously. Often,these routines include some type of retinoid. As previously mentioned, retinoids are contraindicated in pregnancy. Retinoids can be replaced with ingredients such as vitamin C, niacinamide, Hyluronic acid and peptides. All deemed as safe to use in pregnancy and lactation.
Niacinamide
Multiple studies have shown that niacinamide works to improve the skin barrier, help with hyperpigmented spots, improve fine lines and wrinkles.It has also been used in the past to treat skin conditions that are exacerbated during pregnancy, like rosacea.
Peptides
Peptides are amino acids that naturally occur in the skin and help boost elastin and collagen production. Recommendation:
Hyaluronic Acid
Hyaluronic acid (HA) is a form of sugar that is naturally produced by our bodies which helps lock-in the moisture in our skin. It helps to maintain the skin hydrated and it provides a “plump” effect which reduces the appearance of fine lines and wrinkles.
Disclaimer
The above list is supposed to be for educational purposes only. Always remember that before starting a new skin care regime to consult with your healthcare provider.
References
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