Pregnancy-safe skincare: which ingredients to pause and which you can keep

ROUTINE

Which skincare ingredients should you pause during pregnancy?

During pregnancy, you pause retinoids, hydroquinone and strong acid peels, and you discuss anything on prescription with your doctor. This short list is more honest than the long lists of banned ingredients that circulate online. A review from the Motherisk Program in Canadian Family Physician concludes that most skincare products act locally and that only minimal amounts enter the body. As exceptions, it names hydroquinone, which is absorbed to a comparatively high degree, and tretinoin, for which the evidence is disputed. The same precautionary principle applies to retinol and retinal, because the skin converts part of them into retinoic acid – the very substance that is the active ingredient in tretinoin. Many other substances on warning lists, by contrast, are there as a precaution or because they can irritate, not because of a proven risk to the baby. Before you clear out your entire bathroom cabinet, it is therefore worth checking which warning lists about harmful ingredients actually hold up.

• Retinoids: retinol, retinal, retinyl esters and the prescription-only tretinoin, adapalene and isotretinoin.
• Hydroquinone, as used in lightening products for dark spots.
• Chemical peels with a high acid concentration, as offered in salons or clinics.
• Any skin, acne or pigmentation treatments you were prescribed before your pregnancy.

Why are retinol and other retinoids off limits during pregnancy?

Retinoids are off limits during pregnancy because the tablet form is proven to cause severe birth defects, and a residual risk cannot be ruled out with certainty when they are applied to the skin. The evidence on the tablet form comes from a study in the New England Journal of Medicine: it analysed 154 pregnancies with exposure to isotretinoin and found a relative risk of 25.6 for a group of selected major malformations. For creams and gels, the picture is considerably calmer. A meta-analysis in the British Journal of Dermatology covering 654 pregnant women who had used topical retinoids in the first trimester found no significant increase in major malformations. The authors themselves note, however, that the statistical power is not sufficient to justify use during pregnancy. The review in Canadian Family Physician also cites four case reports of birth defects after topical use, set against two prospective studies that found no increased risk.

For you, this means two things. If you used retinol before you knew you were pregnant, the data gives no reason to panic, but it is worth raising at your next appointment. From the moment you get a positive test, leave out retinol, retinal and retinyl esters. Prescription retinoids belong in medical hands anyway. Which strength to come back to later, and when to start retinol again, is something you can work out calmly once pregnancy and breastfeeding are behind you.

Are salicylic acid, AHAs and other acids safe during pregnancy?

Salicylic acid in ordinary skincare products and mild fruit acids are considered acceptable during pregnancy, whereas high-strength peels are something to discuss beforehand. The Motherisk review puts the absorption of salicylic acid through healthy skin at anywhere from undetectable to 25 percent, depending on the base, pH, concentration and amount. Because only a relatively small share enters the body, the authors consider a risk unlikely. Up to 27 percent of glycolic acid, the best-known fruit acid, is absorbed into the skin. Adverse effects on reproduction are known only from animal studies using doses far above anything found in cosmetics; there are no studies in pregnant women. What matters, then, is the amount per area and over time: a cleansing gel you rinse off after a minute is a different matter from an acid peel left on over a large area. A review in the Journal of the American Board of Family Medicine names azelaic acid as a first-line option for acne during pregnancy, but as a treatment prescribed by a doctor. How salicylic acid works inside the pore and which skin it suits is covered in our guide to salicylic acid: what it does and who it suits.

Which skincare ingredients are considered safe during pregnancy?

Skincare ingredients that work on the surface of the skin and are already familiar to the body are considered safe: hyaluronic acid, glycerin, ceramides, squalane, panthenol, niacinamide and vitamin C. Hyaluronic acid and ceramides are natural components of the skin, niacinamide is a form of vitamin B3, and you know vitamin C from your diet. Even so, there are no dedicated pregnancy studies on topical use for most of these substances. Put honestly, safe here means there are no signs of a risk and no plausible route by which a facial skincare product could carry relevant amounts of them to the baby. That is an assessment, not a guarantee.

One example of a routine without retinoids or fragrance is The Duo of serum and cream, with 5% niacinamide, 2% vitamin C as 3-O-Ethyl Ascorbic Acid and hyaluronic acid in three molecular sizes. One point needs saying openly, though: the cream contains bakuchiol, and there is no data on bakuchiol during pregnancy. That is why we do not call The Duo pregnancy-safe, and instead recommend that you go through the ingredient list with your gynaecologist.

How much of an ingredient actually gets through the skin into the blood?

With most skincare ingredients, only a small part gets through the skin into the bloodstream, and how large that part is depends heavily on the substance. The outermost layer of the skin is an effective barrier, especially against large or water-loving molecules. The same review shows the range: only 5 percent of benzoyl peroxide is absorbed through the skin, and it is then completely broken down into benzoic acid, whereas for hydroquinone the figure is 35 to 45.3 percent. These figures show why blanket lists of banned ingredients are of little help. What counts is how much of a substance is absorbed, how large the area is and how often you apply it. More gets in when the skin is broken or badly irritated, when a product is covered with an airtight layer or when you use it over large areas of the body. A few drops of serum on your face, by contrast, are a small amount on a small area. With retinoids, caution is still justified, because the same class of substances carries a proven risk in tablet form, so even small amounts are weighed differently.

How does your skin change during pregnancy, and what does it really need now?

The hormonal changes of pregnancy often visibly change the skin: many women notice darker patches on the face, drier or more sensitive skin, and some develop breakouts they never had before. The Motherisk review itself opens with a question from general practice: patients complaining of breakouts and other skin problems that only appeared with pregnancy. Dark, patchy areas on the forehead, cheeks or upper lip may be melasma. That calls for a check-up with a dermatologist, not a do-it-yourself experiment with lightening products. What the skin needs during this time is surprisingly little. You can do without experiments with new active ingredients, constantly switching products and anything else that adds irritation.

1. Cleanse gently: water or a mild cleanser that leaves no film and no feeling of tightness.
2. Add moisture: a serum with humectants such as hyaluronic acid or glycerin.
3. Support the barrier: a cream with lipids such as ceramides or squalane.
4. Use sunscreen every day: it matters more now than any active ingredient, because UV light increases the tendency to develop dark spots.

Do the same rules apply while breastfeeding as during pregnancy?

While you are breastfeeding, the question shifts: it is no longer about the development of the baby in the womb, but about whether a substance passes into breast milk or reaches the baby directly through the skin. For facial skincare with niacinamide, vitamin C, hyaluronic acid or ceramides, this changes little. With retinoids, the simplest approach is to extend the break until you stop breastfeeding and to discuss restarting earlier with your doctor or a breastfeeding adviser. The same applies to hydroquinone, strong peels and prescription treatments. One practical rule is added while breastfeeding: everything you apply stays where it belongs. Keep your breasts and any areas of skin where your baby feeds or rests their face free of products with active ingredients. And because lack of sleep and hormonal changes often make the skin more sensitive after the birth, a short, calm routine is worth more than new experiments here too.

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