Navigating Skincare During Pregnancy: The Retinoid Dilemma
Pregnant individuals often receive diverse advice regarding the safety of skincare products, especially those containing retinoids. These vitamin A derivatives are widely used to address skin concerns such as acne, wrinkles, and pigmentation, and are considered "gold standard" ingredients by chemists like Michelle Wong. There are different types of retinoids, categorized by their potency and availability.
Types of Retinoids
- Prescription-only: These include oral isotretinoin and topical treatments like tretinoin, tazarotene, and trifarotene. Oral retinoids are confirmed to be unsafe during pregnancy due to the risk of birth defects, a warning clearly stated on their packaging. Prescription topical retinoids also carry similar warnings.
- Non-prescription: This category includes adapalene, which is available from pharmacists, and over-the-counter (OTC) options like retinol and retinal, found in topical creams and serums at lower concentrations.
Conflicting Advice on Topical Retinoids
For OTC topical retinoids, advice for pregnant women is less clear and often conflicting.
- Support for Safety: NSW Health's Mothersafe service and chemist Michelle Wong suggest that OTC topical retinoid creams are safe for pregnant women due to their topical application and lower dosages, advising caution primarily with prescription topical treatments.
- Caution Recommended: Maternal fetal medicine specialist Laura Gerhardy indicates insufficient research to make definitive statements on the safety of topical retinoids during pregnancy, noting that they often treat non-vital conditions like acne. Similarly, dermatologist Deshan Sebaratnam advises pregnant patients to avoid all retinoids, including retinol, as a precautionary measure, despite acknowledging a low absolute risk. The American College of Obstetricians and Gynaecologists (ACOG) also does not recommend either prescription or OTC topical products, even though systemic absorption is low.
"The limited data on both prescription and OTC topical retinoids contributes to the varied guidance from health practitioners."
Labelling and Research Limitations
There are no mandatory labelling standards for cosmetic skincare products containing retinoids such as retinal and retinol, with only adapalene products requiring specific warnings since their reclassification as pharmacist-only. Dr. Gerhardy attributes this lack of clear labelling to the absence of specific guidelines, contrasting it with the straightforward warnings for oral retinoids. The limited data on both prescription and OTC topical retinoids contributes to the varied guidance from health practitioners.
Accidental Use During Pregnancy
"If topical retinoids are accidentally used once or twice during pregnancy, experts like Dr. Wong advise against panic."
The amount of product absorbed into the system from topical application is generally quite low, even with prescription creams, though tretinoin is considered to carry a higher risk.
Recent Research
A Nordic study published recently found no evidence of an increased risk of birth defects in babies exposed to topical retinoids during pregnancy, despite a significant increase in their use over the past two decades. While the authors described this as the "strongest evidence to date on the safety of topical retinoids during pregnancy," they also noted that the study might underestimate risk and emphasized the need for further research.
Other Skincare Ingredients to Consider
Healthcare practitioners also recommend caution with other skincare ingredients:
- Avoid: Professor Sebaratnam suggests avoiding minoxidil (for hair growth) and hydroquinone (for dark spots).
- Salicylic Acid: Dr. Wong cautions against high doses of salicylic acid, a chemical exfoliator, though Mothersafe NSW considers smaller doses safe. The safety of use should be confirmed with a healthcare provider in specific situations where absorption may be higher.
- Unregulated Products: Dr. Wong also advises caution regarding beauty products purchased online without verified information.
For most pregnant individuals, the safest approach involves sticking to well-regulated products and consulting a healthcare practitioner for personalized advice.