Safe skincare during pregnancy: Why retinol is a no-go

You've heard about the wonders retinol can do for your skin. Retinol has revolutionised the skincare market: it's a winner for minimising dark spots and acne and reducing fine lines and wrinkles. It boosts collagen production and shifts dead skin cells from the skin giving users a glowing complexion.

But did you know that if you are pregnant, it's recommended that you avoid retinol altogether? Oral and topical retinoids are linked to a range of pregnancy-related problems that can affect a growing baby.

Here is an informative guide on what retinoids are, and why they should be avoided in pregnancy.

What is retinol?

Retinoids are a class of vitamin A derivatives commonly used in skincare products due to their proven efficacy in treating various skin conditions, including acne and signs of ageing.

Retinoids and retinol have been serious game changers in the skincare industry since the 1970s: the American Food and Drug Administration approved a topical use retinoid in 1971, and it's been a staple of every serious skincare regime since then.

Retinoid is a catch-all term for skincare involving vitamin A. Retinol, however, encompasses the over-the-counter vitamin A products you can buy for your skin. Retinol is within the broader retinoid family and is commonly available in over-the-counter skincare products such as retinol creams, lotions or serums [1].

Retinol is often perceived as an exfoliant because of the sophisticated way it promotes skin cell turnover, but it's actually an antioxidant [2].

It is the most potent form of vitamin A that you can buy over the counter; the key differences between retinol and retinoids are their strength and accessibility.

What does retinol do for the skin?

When retinoids are applied to our skin, they are converted into retinoic acid [1]. Different kinds of retinoids can take longer to convert but all retinoids lose some of their strength during the conversion process. The closer you are to retinoic acid, the better it works for your skin [3].

Once the conversion happens, your body is able to bind the retinoic acid to a receptor and begin working [2]. In the process, it will:

• Improve your skin's texture by boosting collagen production and minimising wrinkles
• Even out skin tone including hyperpigmentation and in repairing sun-damaged skin
• Help clear acne-prone skin by unclogging pores

The promotion of collagen production helps maintain skin elasticity, softening fine lines and wrinkles with the use of retinoids and retinol and preventing new wrinkles from forming.

As you can see, it's no wonder retinoids are here to stay on our shelves. However, it's extremely important to remember that retinol isn't for everyone, especially not pregnant women.

Is it safe to use retinol during pregnancy?

While many in the skincare world wax lyrical about the brilliance of retinoids as a skincare treatment because of the mountain of evidence to prove its effectiveness in reducing the signs of ageing and acne, a particular skincare routine should never come at the cost of your safety. And, if you're pregnant, it is not worth putting your developing foetus at risk.

So the answer is no: it is not considered safe for people to use retinol or retinoids during pregnancy.

Foetal retinoid syndrome

Retinoids, especially high-dose oral retinoids, can have a teratogenic effect on a pregnancy — meaning they can harm a developing foetus [4].

Healthcare providers advise against even topical retinoids — using retinol in pregnancy on the skin can mean it can absorb into the bloodstream, potentially crossing the placenta and reaching the foetus.

High doses of retinol or retinoids in pregnancy are linked with foetal retinoid syndrome, also known as retinoic acid embryopathy [5]. Studies indicate that excessive vitamin A exposure during pregnancy may disrupt normal foetal development, potentially leading to malformations of the central nervous system, heart, and other vital organs.

High exposure to vitamin A can also lead to developmental and intellectual disabilities, cleft palate, midface hypoplasia and other birth defects. What's more, it can also lead to spontaneous miscarriages.

That's not to say that you should avoid vitamin A completely while pregnant: vitamin A is actually essential for the maintenance of maternal night vision, foetal eye health, and the development of other organs, the foetal skeleton and the foetal immune system [6].

It's excessive vitamin A intake that can harm your baby. Retinoids have a high concentration of vitamin A, as do liver products such as pâté — another product to avoid during pregnancy.

Leading medical organisations, including the American College of Obstetricians and Gynecologists (ACOG), advise pregnant women to avoid retinoids and any other potentially harmful substances during pregnancy [7]. It is crucial to consult with healthcare professionals, such as dermatologists or obstetricians, for advice on suitable skincare products and routines.

What happens if you accidentally use retinol while pregnant?

If you've accidentally been using topical retinoids or retinol while pregnant, don't panic. Ensure you stop taking them immediately and then speak to your healthcare provider as soon as possible.

Let your doctor know how much you've been having so they can watch the rest of your pregnancy closely.

Are there any alternatives to retinol during pregnancy?

Yes! A good skincare regime doesn't stop at retinoids. There are plenty of safe alternatives to retinoids that pregnant people can latch onto for healthy skin.

All retinoid-free cleansers and moisturisers can still be used to keep your skin looking shiny and soft. You also can and should incorporate a broad-spectrum SPF, like Software's Daily Sun Defence SPF50+, into your skincare regime while pregnant.

Pregnant people may experience sunburn more easily due to increased blood flow, which can enhance the skin's reaction to UV radiation.

To get soft, hydrated skin during pregnancy, incorporating products such as hyaluronic acid, azelaic acid, niacinamide and vitamin C are all safe to use due to their low absorption levels.

You can also continue to use benzoyl peroxide as an acne treatment. There is no evidence to suggest that using it in small amounts will affect your developing baby.

If you suffer from pregnancy-related dry skin, it's recommended that you use gentle exfoliants like lactic acid or a light scrub for removing dead skin cells. Keep it gentle, though; you don't want your poor skin to be red and angry thanks to powerful exfoliants.

Moreover, natural oils like rosehip or tea tree oil are fine for your skin and your growing baby.

Always speak to your healthcare provider about your skincare regime while pregnant, to make sure you are staying on top of your and your baby's health.

Are there any other ingredients to avoid?

There are some skincare ingredients where the jury is still out on whether they are safe during pregnancy.

Salicylic acid

Using high doses of salicylic acid is considered unsafe in pregnancy, as they are also linked with having teratogenic effects.

Although the usual amount of salicylic acid absorbed from topical use is quite low, there's still a possibility of systemic absorption into the bloodstream, especially in higher concentrations or with prolonged use.

Salicylic acid belongs to a class of medications called salicylates, and high doses of oral salicylates, such as aspirin, have been associated with negative effects on the foetus [8].

Skin-lightening ingredients

Using skin-lightening ingredients to treat hyperpigmentation should also be stopped during pregnancy. While there is limited evidence regarding its safety during pregnancy, it is generally recommended to avoid using it during this time.

Some animal studies have suggested possible adverse effects, including developmental toxicity, decreased foetal weight, and skeletal abnormalities [8].

Alpha-hydroxy acids

There is no evidence to suggest that alpha-hydroxy acids will affect a developing foetus, but they can affect you in other ways. Pregnancy usually makes your skin quite sensitive and adding AHAs, like glycolic acid, onto already sensitive skin can make it inflamed and angry with redness, stinging or discomfort.

However, this won't affect all pregnant people in the same way, so it might be good to try out AHAs as a patch test on your wrist before adding it to your face. Lactic acid, for example, is a gentle AHA and it might be a good option for pregnant people with itchy, dry skin [8].

Can you use retinol while breastfeeding?

While there is no strong evidence to suggest that topical use of retinol is harmful to a breastfeeding baby, healthcare providers still recommended to avoid it during this time.

This is because medicines and vitamins absorbed into the bloodstream will be passed through breast milk and onto the baby. As always, talk to your healthcare provider about your retinol dosage and your skincare goals to make sure you are keeping yourself and your baby safe [8].

Software's Australian health practitioners can create you a bespoke skincare routine to help manage the skin's pregnancy-related problems.

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