Another product to add to the list is retinol, which should be avoided during pregnancy. If you are unfamiliar with retinol, think of it as a multitasking skincare powerhouse. This favorite of dermatologists can help with a range of skin concerns from anti-aging to acne. We asked the professionals if it is safe to use this skincare staple while expecting. Keep reading to learn what two board-certified dermatologists have to say about using retinol while pregnant, including what the risks are and what you can use instead.
What Is Retinol?
Retinol is in a chemical family known as retinoids. “Retinoids and retinol are chemicals that are derived from Vitamin A,” explains Rachel Nazarian, MD, a board-certified dermatologist at the Schweiger Dermatology Group in NYC. They can be found in skincare serums, gels, and creams. Retinol and retinoids go by a range of names in over-the-counter (OTC) and prescription forms. The standard OTC ingredient is called retinol. It comes in different potencies, such as retinyl palmitate, which is its weakest form. Then, there is retinaldehyde, an OTC that is stronger than regular retinol. There are also prescription retinoids like tretinoin, bexarotene, adapalene, alitretinoin, and tazarotene. All of these start to work immediately when put on your skin. Retinoids, in comparison, are stronger than retinol, but they need to be converted in your body before your skin starts to react to it. “Retinoids [have] classically [been recieved] through a prescription in the past,” Dr. Nazarian shares. Retinol and retinoids are both cult- and dermatologist-favorites because of their skin benefits. “They [encourage] the skin cells to make collagen, which makes skin appear more youthful, and can stimulate the surface cells to slough off, making skin smoother," says Dr. Nazarian. “They also decrease oil gland production, making them a tool to fight acne.” Retinol also supports increases elasticity, treats fine lines, improves texture and tone, minimizes the appearance of pores, and improves discoloration. They do all this by working directly with your skin cells. “Vitamin A derivatives like retinol work by binding to receptors in the skin and triggering skin benefits,” says Blair Murphy-Rose, MD, FAAD, a board-certified dermatologist at the Laser & Skin Surgery Center of New York in NYC and the Hamptons. However, keep in mind that they are both potent skincare ingredients. Dr. Nazarian forewarns that it will take time for your skin to adapt when you first start using either retinol or a retinoid. They can initially be drying for your skin and cause redness or flakiness. Dr. Nazarian also advises always wearing sunscreen if you are using retinol. Retinol makes your skin more sensitive to photodamage, so it is ultra-important to protect your skin with SPF when using it.
Is It Safe to Use Retinol During Pregnancy?
While the skin benefits of retinol are vast, during pregnancy, you ought to stay away. The risks to your unborn baby can be potentially serious and life-long. “While there has not been evidence to suggest that topical vitamin A derivatives like retinol cause birth defects, we exercise an abundance of caution with these topicals and advise avoidance during pregnancy and breastfeeding,” explains Dr. Murphy-Rose. “We know that ingredients applied to the skin have the potential to be absorbed into the bloodstream and passed to the baby through the placenta.” Research confirms that retinol can be transferred from parent to baby through the placenta, and up to 60 times more while breastfeeding. And the American Academy of Dermatology specifically names retinoids on its list of ingredients that are unsafe during pregnancy and should be stopped immediately. Fortunately, there are alternatives with similar benefits to retinol that you can use. (More on those in a bit.)
Why You Should Not Use Retinol While Pregnant
Dermatologists practice an abundance of caution when it comes to topical retinol because of the potentially serious side effects. “Systemic retinoids (those taken by mouth) cause birth defects,” says Dr. Murphy-Rose. Even though there is a difference between ingesting a retinoid and putting it on your skin, the risks are so great that experts think it is better to be safe and avoid both altogether.
Risks of Using Retinol While Pregnant
The risks of using retinoids and possibly retinol during pregnancy include a condition called “fetal retinoid syndrome.” Specifically, this is a pattern of physical and mental birth defects that arise in direct relation to retinoids. The types of deformity and severity vary but tend to impact prenatal and postnatal growth, along with several systems in fetuses. “There is thought to be an 18% to 28% risk of a developmental defect occurring in an embryo or fetus,” Dr. Murphy-Rose says. “The most common abnormalities [that occur] are craniofacial, cardiac, central nervous system, and thymic malformations.”
Craniofacial Malformations
Some infants have shown abnormalities in their facial structures when retinoids are used during pregnancy. These include small, low-set ears (microtia) with narrow ear canals (stenosis) or even a lack of ears altogether. They can also have malformations in their inner ears, which can lead to hearing loss. Other developmental impediments include widely-spaced eyes (hypertelorism), underdevelopment of the midface (midface hypoplasia), a cleft palate or lip, or paralysis of certain facial nerves (palsy).
Cardiac Malformations
Using a retinoid while pregnant also puts your baby at risk of potential cardiovascular abnormalities, which involve malformation of their heart. These afflictions include a hole in the heart (ventricular septal defect, or VSD), reversed positioning of major arteries (transposed great vessels), four concurrent abnormalities of the heart and major vessels (tetralogy of Fallot), and critical underdevelopment of the left side of the heart (hypoplastic left heart syndrome).
Central Nervous System Malformations
Babies whose mothers used a retinoid while pregnant are also at risk of developing abnormalities in their central nervous system. For instance, an accumulation of excess cerebrospinal fluid in their skull can increase pressure on their brain, resulting in developmental delays or disabilities. This can also cause microcephaly, a condition where an infant’s head is smaller in circumference than it should be. Microcephaly can result in developmental and intellectual disabilities, as well as issues with coordination and balance.
Additional Malformations
Another risk factor of using retinoids while pregnant is inadequate functioning of the thymus gland—a crucial part of the lymphatic system that makes white blood cells to fight off infection. Other deformities that can occur are malformations of the spine and legs, inadequate muscle tone (hypotonia), a lack of eyes, and one or both eyes that are too small, which may result in vision loss (anophthalmia). Babies exposed to retinoids in utero can also develop webbed fingers (syndactyly).
When Can I Resume Using Retinol?
Dr. Murphy-Rose advises only starting back on retinol when you are no longer pregnant or breastfeeding. Due to the risks associated with retinoid use during pregnancy, it is best to be on the safe side. Be sure to check with your healthcare provider to be sure you and your baby are in the clear.
Pregnancy-Safe Alternatives
Fortunately, there are skin care alternatives to retinol that doctors give the green light on. “There are a lot of other options for skincare in pregnancy, so speak to a board-certified dermatologist when the time comes,” Dr. Nazarian advises. “Consider ingredients like azelaic acid, kojic acid, and glycolic acid.” You can find such ingredients in a range of brands from affordable ones like Neutrogena and Paula’s Choice to more high-end brands, such as Skincueticals, Murad, and Kiehl’s. “The important thing to remember here is that not all OBs follow the same rules, and some may be more comfortable or less comfortable with you using [certain] ingredients while pregnant and breastfeeding,” Dr. Nazarian adds. “Always run your regimen by them and get their blessing before starting!” The same applies to any foods or activities that may be suspect. Here are a few pregnancy-safe alternatives to retinol that you can add to your routine.
Glycolic Acid
Glycolic acid is an alpha-hydroxy acid (AHA) used in many skin care products as a gentle exfoliant. “Glycolic acid (and other alpha-hydroxy acids) shares many skin benefits with retinol including exfoliation, reduced hyperpigmentation, some stimulation of collagen production (though not to the same extent as retinol), and treatment and prevention of acne,” Dr. Murphy-Rose says. “AHAs exfoliate the outermost skin cells, revealing a brighter, more glowing complexion.” Though there have been no concrete studies of glycolic acid use during pregnancy, research included in the National Institutes of Health Library supports its use while pregnant. Only large amounts of glycolic acid have shown adverse effects on animal embryos and fetuses. The comparably minuscule amount found in topical skincare should not warrant any concern, since only a small bit is absorbed into your system.
Vitamin C
While you may associate vitamin C with foods and tasty breakfast beverages, it is also an effective skin care ingredient, especially when it comes to brightening and evening skin tone. It also fights free radicals, which are unstable molecules that can damage skin. “Vitamin C boosts collagen production and fights hyperpigmentation, similar to retinol. It also protects against environmental skin damage, and treats and prevents skin aging as a potent antioxidant,” Dr. Murphy-Rose says. “However, vitamin C does not regulate cell turnover or prevent acne as retinol does. Look for a product containing high-quality, pure L-ascorbic acid for the best results.” People who are pregnant are already advised to take a vitamin C supplement orally—around 85 mg daily—to help promote healthy gums, teeth, and bones, as well as to support immunity. This is far more than you would get from your skincare, so it makes complete sense that it is safe to use vitamin C topically. Of course, always speak to your healthcare provider before starting any supplements.
Niacinamide
Pregnant people are also advised to take an oral supplement of 18 to 35 mg of niacin daily for healthy skin, digestion, and nerves. You would be applying much less than that via your skincare. Also known as vitamin B3, topical niacinamide is soothing to the skin, can help improve the appearance of acne, and protect against sun damage. (Though SPF is still a must!) “Niacinamide, or vitamin B3, has similar skin benefits to retinol without causing irritation,” Dr. Murphy-Rose explains. “It has been shown to smooth skin and decrease the appearance of pores.” It also bests retinol in other ways. “Niacinamide will not cause irritated, flaky skin the way retinol often does,” she continues. “In fact, it is a multifunctional, skin-restoring ingredient that boosts the hydrating ability of other moisturizers when used together and helps to prevent moisture loss.” By helping with hydration, niacinamide helps maintain your skin barrier, which shields your skin against environmental aggressors.
Hyaluronic Acid
Then, there is hyaluronic acid, a water-loving molecule with a unique capability to boost hydration. Dr. Nazarian is a fan of swapping out retinol with hyaluronic acid while pregnant since a key to healthier-looking skin is hydration. “Hyaluronic acid (HA) is a substance found naturally in our tissue, and its job is to keep our skin well-moisturized and hydrated from the inside,” she explains. “HA can draw in and hold many more times its weight in water. It is a completely safe and natural substance, and can be used topically to temporarily improve moisture in the skin.” When it comes to its safety while pregnant, there is no cause for concern. “It is a substance that is safe during pregnancy and breastfeeding,” Dr. Nazarian reassures. “There is really nothing special to be concerned about with hyaluronic acid! I think most women in pregnancy would appreciate using this ingredient in their skincare regimen because it is very lightweight, applies evenly, and can be quite hydrating and soothing to the skin.” You can find hyaluronic acid in a whole slew of skincare products, from cleansers, mists, and essences to serums, oils, and moisturizers. It is even an active ingredient in some hair products due to its deeply hydrating benefits.
Ceramides
Lastly, Dr. Nazarian recommends ceramides as a good option as well. “If you are looking for alternatives, consider products that contain ceramides, which can also help improve the hydration barrier of skin.” Similar to hyaluronic acid, ceramides are naturally produced by the body. And, like hyaluronic acid, our intrinsic ceramide production decreases with age. You can help restore this skin-loving lipid to help combat signs of aging and skin-thinning.
A Word From Verywell
Simply put: There are some pretty severe and lifelong risks that can occur in your developing baby if you use retinol while pregnant. But you don’t have to give up on your skincare routine just yet. There are plenty of alternatives. Speak with your healthcare provider, OB/GYN, or dermatologist to see what ingredients are right for you.
