As a plastic surgeon and a woman five months into my first pregnancy, I thought I had a solid understanding of how to adjust my skincare routine while growing a small human. However, when I began to closely examine ingredient lists and the literature (or lack thereof) surrounding them, I started having second thoughts.

My two main skin concerns have always been acne and graceful aging. Once I started trying to conceive, I stopped using my usual routine of topical retinoid, hydroquinone, oral spironolactone, salicylic acid, and Botox®. This was based on my understanding of what is safe and what my midwife advised me to avoid. But I began wondering, is it all really necessary?

With so many skincare products on the market, choosing a regimen is already daunting. Add the concern about safety for your growing baby, and it can feel almost impossible. In this article, I’ll offer advice on general skincare during pregnancy and explore the safety of some common active ingredients for treating typical skin concerns.

One major problem I encountered is the lack of high-quality studies to reliably inform pregnant or nursing mothers about the safety of many skincare products. Conducting randomized controlled trials on pregnant women and their babies raises ethical concerns. Therefore, we rely on limited studies that tell us how much of a topical medication is absorbed through the skin and what defects have been associated with similar medications. Where evidence is lacking, it's often safer to simply avoid certain products until more information is available.

It's crucial to know that the ingredients listed on skincare products are accurate, and that the products have been tested for safety and efficacy. Unfortunately, not all products meet these standards, especially with the rise of counterfeit products online. Investing in medical-grade skincare—available through a doctor’s office or a medspa overseen by a physician—can help ensure you’re getting a high-quality product with accurate labeling and proper testing.

Many women switch to natural products during pregnancy in hopes of living cleaner and healthier. While this seems reasonable, an "all-natural" label doesn’t guarantee a product is safe for a developing baby. Natural products are not regulated as medications, so they don’t undergo the same rigorous testing for pregnant and breastfeeding women. It's best to avoid these products unless you’re certain of their safety. Always read labels and consult your healthcare provider.

Pregnancy can worsen acne due to increased sebaceous gland activity, though some women do report improvements. Here's a breakdown of what to avoid and what is safe:

- Not Recommended: Hydroquinone, Vitamin A derivatives (retinol, tretinoin, isotretinoin), and oral tetracycline should be avoided. Hydroquinone is highly absorbed through the skin, and isotretinoin is linked to birth defects. Retinoids, even topical, have been associated with birth defects.

  

- Safe: The American College of Obstetricians and Gynecologists (ACOG) recommends glycolic acid, azelaic acid, benzoyl peroxide, and topical salicylic acid (<2%) for acne. Topical clindamycin may also be prescribed.

- Not Recommended: Neurotoxins, laser treatments, and Vitamin A derivatives are not safe.

  

- Safe: Peptides, enzymes (too large to be absorbed through the skin), and mineral sunscreens are safe options for maintaining healthy skin during pregnancy.

Up to 90% of pregnant women experience hyperpigmentation, with melasma being particularly common. Here's how to manage it:

- Not Recommended: Hydroquinone, laser treatments, and most chemical peels should be avoided.

  

- Safe: Topical Vitamin C, peptides, and glycolic or lactic acid peels can help manage pigmentation concerns.

Stretch marks affect 63%–90% of pregnant women, often appearing in the sixth or seventh month. While no product can cure stretch marks, keeping your skin healthy and providing the nutrients it needs for cell growth may reduce their severity. Topical products with hyaluronic acid and vitamin E, applied with daily massage, might help, though evidence is limited. After pregnancy, treatments like retinoic acid and resurfacing lasers can help, but they should be avoided during pregnancy.

For more information on medication safety during pregnancy, you can consult the following resources:

- FDA Drug Safety Information: [FDA Drug Information](https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm)

- Fact sheets from MotherToBaby: [MotherToBaby](https://www.mothertobaby.org/)

- Download the LactRX app for quick searches on medications and supplements: [LactRX App](https://mothertobaby.org/lactrx/)

In summary, while it's tempting to continue your usual skincare routine during pregnancy, many products should be avoided or approached with caution. Always consult your healthcare provider for personalized advice on what’s best for you and your growing baby.