20 September 2019
Pregnancy is a very exciting milestone but it too, can be a confusing time for mothers. First of all, changes in levels of hormones cause changes to the skin- from the coveted pregnancy glow to problems like acne and melasma. Secondly, there is the more complicated issue of knowing whether your skincare, medications and treatments are safe for pregnancy and/ or breastfeeding.
Having gone through two pregnancies has made me realise how confusing and neglected the topic of safe skincare ingredients and practices can be. And I can imagine how much more challenging it is for most of you to navigate the skincare scene safely for pregnancy and breastfeeding.
This guide was written to help you choose safe skincare and identify unsafe skincare ingredients. I’ll also be sharing recommendations on skincare ingredients to include to cope with some of the dermatological problems that can arise during pregnancy and after. This guide will also cover the topic of whether dying your hair is safe during pregnancy (this question was a popular one!). I hope that you will find this skincare safety guide for pregnancy and breastfeeding to be useful.
One easy, albeit simplistic, guide to quickly knowing whether the ingredients or medications you are using are safe is to use the US FDA Pregnancy Categories for Drugs.
This safety rating designed by the US FDA for drugs in pregnancy is based on human observations and animal studies. Essentially, categories A and B are safe for use during pregnancy. Categories C, D and X are to be avoided because of their potential to cause birth malformations and miscarriages. This safety rating has now been replaced with a longer and more complex safety labelling since 2015 but you will still find some drug companies and websites using this old labelling. Please bear in mind that this safety categorisation does not take into account safety during breastfeeding.
When in doubt, scrutinise the ingredient lists and check with your doctor. Even products labelled as ‘natural’ or ‘organic’ need to be approached with a healthy dose of scepticism. ‘natural’ and ‘organic’ product have not been extensively studied in pregnant and lactating mothers to ascertain their safety.
My guide to choosing sunscreens and reviews are in my Sunscreen Reviews: the Best, the Worst and the Unsafe.
You probably already know that sunscreen protects against UV rays that cause sun burns, hyperpigmentation, aging and skin cancer. But did you know that sunscreen is especially important during pregnancy because of a hyperpigmentary disorder called melasma that can develop anytime during the pregnancy?
Melasma is a very common problem faced by pregnant women and it can also occur in women taking oral contraceptives. It typically appears as brown to grey-brown patches on both sides of the face on the cheeks, forehead and upper head. Melasma is notoriously difficult to treat because it has a hormonal factor and it can recur even after pregnancy. It is easier to prevent melasma by using sunscreens.
There are some concerns about using chemical sunscreen filters like Octinoxate and Homosalate as these chemicals have been found to enter the bloodstream. My post Sunscreen Trends and Controversies has covered these safety issues on sunscreen use in pregnancy. If in doubt, use physical sunscreen filters like zinc oxide and titanium oxide as they are far safer.
One of the more affordable OTC Azelaic Acid formulations I’ve used is The Ordinary’s Azelaic Acid Suspension 10%.
Azelaic acid is another skincare ingredient that is safe and suitable for treating some of the common dermatological problems of pregnancy- pigmentation (including melasma); acne and comedones; and sensitive skin and rosacea.
Due to its diverse diverse anti-inflammatory; anti-bacterial and pigmentation lightening properties (as a tyrosinase inhibitor), Azelaic is another versatile ingredient that I would recommend. It’s not the first line treatment for the conditions mentioned above, but it definitely is a safe alternative since many of the first line treatments are unsafe for pregnancy.
Drunk Elephant’s TLC Sukari Babyfacial is one example of a chemical exfoliant. However, one of the ingredients, BHA or salicylic acid, is unsafe for use during pregnancy.
Exfoliation is an essential step to remove dead skin, bacteria and dirt that thrive on the top layer of the skin. This helps to unclog pores, prevent acne and brighten skin. There are many safe ways to exfoliate your skin- from sonic cleansers like Clarisonic and Foreo to non-traumatic methods like alpha hydroxy acids (AHA) to gently remove dead skin cells.
Depending on your skin type, the best method to exfoliate your skin will vary. If you have normal skin, mechanical brushes and sonic cleansers are fine but please remember to be gentle! If you have sensitive skin or rosacea, these might irritate your skin so chemical methods may be more appropriate.
I personally found exfoliating with chemical peels to be more useful in removing my stubborn blackheads and brightening up my skin. During both my pregnancies I made sure to be regular with my monthly chemical peels as retinoids were a big no for me.
Antioxidants protect our skin against free radicals in the environment and pollution that damage our skin, thereby reducing pigmentation and signs of aging. They’re an especially useful pairing with sunscreens to add additional protection against UV ray damage.
Two antioxidants I usually recommend to my patients are vitamin C and niacinamide. Niacinamide is another antioxidant that has multiple benefits- it reduces skin oiliness, reduces inflammation and blemishes at the same time; making Niacinamide another versatile ingredient for skin woes of pregnancy.
One of the big complaints of mothers I hear about after their deliveries is stretch marks. I’ve written about stretch marks and how to treat them in Stretch Marks: A Doctor’s Guide. While stretch marks can be treated with retinoids and fractional CO2 laser after delivery, it is easier to avoid that with prevention. Key to that is a healthy diet, exercise and gradual weight gain. Sudden, drastic weight gains add sudden stretches to the skin to cause striae.
Some skincare ingredients and medications are unsafe for use during pregnancy. Please check with your doctor if in doubt about your skincare.
Most of the skincare and medications to avoid during pregnancy are used to treat acne and pigmentation. Please note that this list of common ingredients and medications to avoid during pregnancy is by no means exhaustive.
Cyspera/ Cysteamine is the latest drug development for treating melasma and was just launched in Singapore this year. The reviews sound promising, however, Cyspera/ Cysteamine is not approved for use during pregnancy and breastfeeding.
● Hydroquinone, Triluma
● Cyspera/ Cysteamine
● BHA/ Salicylic acid
● Retinoids especially Isotretinoin and Tazorotone!
● Antibiotics e.g. Tetracycline, Minocycline, Doxycycline
● Spironolactone/ Aldactone
The results of studies on the use of hair dyes during pregnancy show mixed results. Some studies show a link between hair dyes during pregnancy and an increased risk of cancer (neuroblastoma) as well as low birth weight and the offspring. Some studies suggest otherwise. Based on the equivocal findings of safety of hair dyes during pregnancy, my recommendation is to avoid dying your hair during your pregnancy. Better to be safe than sorry.
If you still would like to use hair dye products during your pregnancy, then my suggestion to wait till the second trimester as the organs are developing during the first trimester.
Third trimester before i popped my second kiddo. Making good use of my baby to hide my food baby.
1. The risk of birth defects from exposure to harmful drugs can occur at any stage of pregnancy. However, the first 10 weeks of pregnancy is considered a critical period during which the baby’s organs are developing. It is during this period that the baby is at highest risk of birth defects. When in doubt, avoid all questionable products during this critical period
2. Sunscreen + Vitamin C is a basic combination that I recommend to anyone, including pregnant and breastfeeding mothers. Melasma is a major problem for most women after pregnancy and treatment is also complicated. Prevention is better than cure, so double up your skin’s protection!
3. Skin problems that arise during pregnancy such as acne can be safely treated with AHA chemical peels, Q-switched laser and LED light; even though medications like retinoids and antibiotics have to be avoided. When in doubt, speak to your doctor. Stay tuned for an upcoming post on common skin problems and aesthetic treatments during pregnancy.
4. Have a healthy diet and exercise! Sudden weight gain stretches the skin to cause striae and stretch marks.
5. Avoid hair dyes if possible!
I hope you find my tips and advice on pregnancy skincare do’s and don’ts useful. Some of the routine skincare ingredients and habits that you may have can be unsafe during your pregnancy so please be sure to check the ingredient list. If you’re in doubt, it’s best to speak to your doctor for clarifications. Stay safe and have a good week ahead x