I’m sure if you’ve been reading my pregnancy skin care series, you know that skin care while you’re pregnant is a bit different than regular skincare. Here I’m addressing specific skin care ingredients and why you might need to avoid them while you are pregnant.
There are definitely some ingredients that you should avoid while pregnant due to possible birth defects. The placenta is basically a big sieve, it lets things through in a very non-specific (and size based) fashion. Your baby is busy doing things like making organs, which means that small mistakes early on can have big effects later on.
While your skin is a barrier, we do know that some of the products you put on it will be well absorbed and those ingredients can reach the blood stream. Which means they can reach the placenta and therefore your baby.
We will never have data regarding safety for many of these ingredients. The studies just wouldn’t be ethical to complete (would you want to be volunteering to try something out and see if it affects your baby? Not me!) so we just make do with the information we do have and try to make some educated guesses.
Pregnancy Skin Care Ingredients to Avoid
They’ve been found in your blood stream, no one really knows what they do… it’s better to stick with the physical sunscreens which sit on the surface of your skin. There have been some published papers linking chemical sunscreens to Hirschsprung’s (1) and hypospadias (2). For this reason, I recommend avoiding all chemical sunscreens while pregnant.
Retin A/Accutane, Retinoids, Vitamin A: Yes, the big baddies here are definitely the 2 prescription drugs listed first. Accutane is a huge issue with pregnancy as it is linked to many different birth defects. In fact, most physicians won’t even prescribe it to women of child bearing age unless they are also on birth control or sign a waiver.
While Retin A and over the counter retinoids are not as strongly linked to birth defects as Accutane, they are all the same class of drug and as such are on pretty much every MD’s list of no-no ingredients. The retinoids are Vitamin A derivatives, and I’ve seen quite a few lists advising to avoid topical Vitamin A as well, so it’s made my list. Yes, there is still Vitamin A in your diet and your prenatal vitamin. It should be there and can take care of your needs. But, no need to add even more in skin care. Here’s a good peer reviewed article regarding retinoids in pregnancy.
Note that Beta-Carotene is a Vitamin A derivative that is considered separately from the retinoids, and it is considered safe.
I get asked a lot about Rosehip Oil as it is high in Vitamin A. All of the OBs I have asked about this specifically state that they consider it ok to use during pregnancy. Rosehip oil has trans-retinoic acid, not the beta-carotene we consider “safe” during pregnancy. Because Rosehips come from plants, the amount of the retinoid in the oil will vary based on how/where the plant is grown, how/when it is harvested and then how/when the oil is extracted. Lots of variables there. I consider it ok to use Rosehip Oil during pregnancy due to my discussions with OB. If it makes you nervous this is something that is easy to avoid.
Note, Bakuchiol is an ingredient that I am currently screening out as a retinoid. Many brands are claiming this is a “natural retinoid” alternative that “works the same way as other retinoids”. But, I can not verify mechanism of action or safety anywhere. It’s likely overkill, but until I can verify those things, I’ll screen it as a retinoid and recommend avoidance.
All Hydroxy Acids
From malic acid to salicylic acid, pretty much all of the hydroxy acids either are not safe or simply don’t have enough information to say “sure, go crazy and rub this all over you.” So, the official word is that all of they hydroxy acids, alpha, beta and poly, have pregnancy categories that recommend avoidance.
One exception is Lactic Acid, which your body makes on its own (I spend a lot of time in the PICU trying to prevent little bodies from making it, but that’s a whole different issue). Lactic acid has been shown to be fine in pregnant animals, but we don’t have evidence in humans. So, the official recommendation is to use with caution, but as it is found in your body anyways…. I don’t screen it out of products. It is in you already.
I’ve seen a few books that say Glycolic Acid is fine, and there are many physicians that tell this to their patients, but it isn’t universally accepted. However, its official pregnancy category is that there isn’t enough info so should be avoided, especially since there is evidence that is is about 28% absorbed when used topically. The “correct” type of study to prove the safety of Glycolic Acid will simply never be done, so many physicians have looked at the current evidence and feel fine recommending it. I personally avoided it while pregnant and it’s one I look for when recommending products as safe or not.
I also want to point out that Citric Acid is found usually in very small amounts at the very end of ingredient lists. It is typically there to help modulate pH in a product. You likely expose yourself to more Citric Acid in one glass of OJ than you would in a year of using such a product. I avoided it in my first 2 trimesters, but lightened up in my third trimester when I realized I was being a bit silly. I ignore it in products.
There isn’t info out there on the safety of Cannabis used topically during pregnancy or nursing. We do know smoking marijuana with THC has bad effects and should be avoided, though it hasn’t been fully decided if it is just the THC or something else as well.
Note that in theory Hemp and CBD do not have THC in them, it’s breed out of the plant is the official status. However, depending upon how it was processed there are CBD oils that test positive for THC. But there are still the unknowns we haven’t decided about. I would not recommend using Hemp or Cannabis products while nursing or pregnant for that reason. Note, this is a highly conservative opinion, but I’m skewed due to my position as a pediatrician.
Dihydroxyacetone (DHA) and Erythrulose are the active ingredient in sunless tanners. The jury is still out on whether sunless tanners are safe. I’ve seen sources that say yes (notably the NHS in the UK), but many that say no. My own OB was anti-sunless tanning while pregnant, it was listed on all of the handouts I was given by the University Clinic, most clinics in the US will state to avoid sunless tanners while pregnant. There is a risk of liver damage due to sunless tanners, even when not pregnant (though this risk is primarily from the sunless tanner pills). Yes, this includes the “natural” sugar products.
I can tell you that my skin has taken on some interesting dry patches while pregnant, and it would be pretty hard to get an even sunless tan. This is a great time to embrace the pale, so I’m going with that.
• Hydroquinone: Though I found it in several drug references as safe in pregnancy, these ingredients were listed on enough lists of things to avoid due to unknown risks that I’m avoiding them. Note that Alpha Arbutin is also in this category. These are all ingredients that more OB/Derms have been adding to their lists of ingredients to avoid.
• Licorice Root acts through inhibition of tyrosine, and it is unclear the effects this could have on an unborn baby. I added licorice root to the list because an increasing number of my OB friends were concerned about this ingredient during pregnancy due to this mechanism of action. Note that licorice root extracts do also have other benefits such as antioxidant activity and it soothes skin.
Licorice root seems to be present in many products, primarily for those other benefits and not the skin lightening effects. But that effect/mechanism is still there. There are several websites that say licorice root is safe for pregnancy, and it might be, but studies won’t be done to prove safety or unsafety.
I err on the side of caution and include it on my list of ingredients to avoid. As I call out the ingredient of concern for every product, if you’re ok with Licorice root it is very easy for you to still use those products, just look for the ones where only licorice root is mentioned as a concern.
• Kojic Acid: This ingredient is sometimes used to help lighten the skin, but it has shown up on multiple lists of items to avoid. I can’t find the reason why, but it seems to be general accepted as an ingredient to avoid.
Again, I can’t find this in any actual drug reference books and a literature search didn’t turn up anything of use, but it is listed over and over on lists of things to avoid while pregnant.
I’ve seen laser therapy, whether for zapping away birth marks, tattoos or hair, listed over and over on lists of things to avoid while pregnant. As well, most places that offer lasers refuse to treat you if you are pregnant.
I would likely reserve lasers (and at home machines) to be used under the direction of your physician. There is some evidence in the medical literature that laser treatment is safe during pregnancy.
This should include topical willow bark and should be avoided. I also include the related chemical sunscreen ingredients in this list as many are related. This is the same reason for avoidance as aspirin during pregnancy. (Which yes, is sometimes prescribed for pre-eclampsia, but that is a time that the risk/benefit ratio is closely monitored by a physician.)
Things I just don’t know enough about
I’m calling out these ingredients, but it’s really because I don’t have enough info and I’m not quite comfortable saying they’re definitely safe. Consider these to be “use at your own discretion” and know that I’m likely being overly cautious. If you’re ok with them, then you can ignore my warnings about them.
First, can I say that I’m not really sure why we suddenly want to put slimy snail stuff on our faces? Who thought of that? It makes me chuckle. Second, we really don’t have a good handle on what is in it, and there’s absolutely no data about safety during pregnancy. I would avoid it.
Stem Cells/Growth Factors
I am worried about these ingredients as they have no safety data, and if they work the way some companies say they work, then I’m not sure I want them on my skin when I’m not pregnant, but definitely NOT when I am pregnant!
Those apple stem cells that are said to penetrate into your skin (which is a barrier by the way, how is a cell in a cream going to break the barrier function to penetrate deep into the dermis?), head to the dermis, where they “proliferate” (aka- multiply) and make the surrounding skin cells do stuff. If this really happened, how do those cells know where to stop? How do you know they aren’t being circulated and heading directly towards the placenta? And doesn’t that sound like apple cancer in your skin? I’d just avoid the whole thing.
• Growth Factors: (Not peptides, those are different) stimulate cells to do various things. This is a pretty generic term and can encompass a lot of different ingredients. I’d look at those on a case by case basis.
Safe skincare Ingredients During Pregnancy
There are a few ingredients that I get asked about frequently. Based on the evidence there’s no reason to avoid these ingredients. There might be random websites that say to avoid them, some of them I can’t even locate the websites but I get asked a lot. These ingredients are safe.
Parabens are currently considered safe by pretty much everyone except the EWG, who have a big propaganda machine and I don’t think they interpret most studies correctly. If you disagree with me about that so be it, I’m just stating my opinion since I’ve been asked over and over. Parabens considered safe for pregnancy and breast feeding. BUT… if an ingredient makes you uncomfortable you should just avoid it. There are so many products on the market these days that it is very possible to do so without any issues.
Hyaluronic acid is basically the same thing as Sodium Hyaluronate
I can’t figure out how this became an ingredient that is sometimes on no-no lists, because not only does your body already make a ton of it, but is a big molecule. Huge. It is so large that it just hangs out in the spot where it is made, much too large to get into cells, to pass through membranes or travel to other locations.
Much is the same for any Hyaluronic Acid that you apply to the surface of the skin. Your skin has very tight membrane junctions between those cells on the surface. Hyaluronic Acid can’t get through and just sits there on the surface of the skin. I’m always very suspicious when a company tells me that their HA is different and can get it. It’s a big red flag.
So, since it can’t get in, and your body is already making it anyways, definitely feel that it is safe to keep using HA in your products. It just sits on the surface and helps hold moisture there. We need it to live up to pregnancy glow expectations!
This is often found in acne treatments, and I haven’t really been able to find much info about safety in pregnancy. Be aware that if you’re allergic to sulfa drugs you should avoid this ingredient, but I’ve seen it as the active ingredient in many “pregnancy safe” acne treatments and is probably fine.
Neem (Azadirachta indica):
While I previously had been calling out Neem as something to watch, I’m not entirely certain upon review with OB friends. This was based on these studies (note, not in humans)- 1, 2, 3. I’ve decided to no longer call out neem as something to avoid until more information comes out.
Various Extracts and Essential Oils
I am frequently asked about specific extracts. Note I’ve only really found convincing evidence that willow bark needs to be avoided in pregnancy, though there are various other websites out there that discuss avoiding specific ones.
I would like to note that during pregnancy you’re a bit more likely to become sensitized/have a reaction to an extract. And what is in an extract exactly can vary depending on how the plant was grown, when it was harvested, how it was extracted, etc. There are a lot of variables. I’m not a big fan of a lot of extracts in my skincare for this reason, and my skin tends to be sensitive to them.
Finally, I do want to point out that there is also moderation in all things. Many things can be more harmful especially in large amounts. I wouldn’t apply a lot of extracts or essential oils while pregnant. I’ve taken care of very ill children in my PICU due to this with “safe” oils such as tea tree oil.
Things I get asked about that I am not worried about
There are many things out there about pregnancy safety (including this blog!) but I would point out that you should consider sources. My list is very conservative overall, but it’s also created by a physician.
Ingredients that I have specifically been asked about but do not have enough evidence currently for me to screen them out:
• Clary Sage
• Propylene Glycol
• Rosemary (remember, you can still eat it, which is a much bigger exposure)
Due to so many comments requesting me to read ingredient lists (of products that I have already put on other posts), I have turned off the comments on this post. Note that reviewing a product can take 10-60 minutes, and requesting me to “quickly look at something” is very time consuming and duplicates a lot of work. If you want to ask about a specific product please refer to how to ask about product safety.
Don’t forget to check out the other articles in my Pregnancy and Nursing Skin Care Guide!