Safe Skincare In Pregnancy: What to use and avoid

DR. DAVID JACK
AUTHOR - DR. JO MENNIE

Pregnancy can throw up a number of skin concerns including acne, dryness and sensitivity, alongside stubborn areas of pigmentation. I often see women in clinic who find the products they were using before pregnancy no longer address their skin concerns. Added to this the uncertainty about what is and isn’t safe to use in pregnancy and breast feeding and it quickly becomes quite overwhelming.

However, there is no need to abandon all active skin care routines. Luckily there are a number of great active ingredients that can address skin concerns in pregnancy safely. The trick is knowing how and when to use these and how to layer products together for maximum results. It is always advisable to consult with a doctor who specialises in pregnancy skincare during your pregnancy as they can assess your skin needs and tailor their recommendations safely for you.

Over the last 7 years or so (partly due to my research for my PhD in women’s health) I’ve consulted women of all backgrounds in how to edit their skincare products to get the most out of them during pregnancy. In the following paragraphs I want to share with you some of my top advice that I give to patients during this time.

What's the one most important thing to bear in mind for skincare during pregnancy in general?

In general, a lot is going on in the body as you are undergoing the amazing feat of growing a tiny human. Be kind to yourself. Your skin will change due to the changes in your hormones  alongside the rebalancing of the immune system that occurs during pregnancy. As such, some of your pre-pregnancy products may not work as well as they used to due partly to changes in your immune and hormone systems. Try and take the time to learn about your skin and get into a good routine before the baby comes.

Fortunately, there are several effective ingredients that can treat acne, signs of ageing, and pigmentation safely during pregnancy and beyond. I would advise seeking help from a doctor specialised in pregnancy skincare who can help advise you on a safe and effective routine during this time.

Which skin treatments can I have during pregnancy, and which treatments should be avoided?

During pregnancy a number of in clinic treatments are not approved owing to a lack of high-quality safety studies in pregnant women. This is unlikely to change due to the ethical implications of researching the effects of non-essential treatments on pregnancy. These include anti-wrinkle injections and filler treatments. Some patients do choose to continue to have these treatments and there have been some retrospective studies showing their safety in pregnancy, however, the lack of prospective studies mean they are not licensed for use during these times.

Some clinic treatments may still be performed, for example gentle peels, dermaplaning and some non-invasive facial treatments such as microneedling. In addition, some of the best biostimulator treatments that boost collagen production such as Profhilo are an effective option once breast feeding is completed to help with fine lines and skin thickness. For stubborn areas of pigmentation post-pregnancy, in clinic Lumecca treatment can be transformational in clearing the complexion.

Are there any products or formulations that are best avoided while I am pregnant?

During pregnancy it is recommended to avoid all retinoids (vitamin A based products) including oral and topical treatments. These need to be avoided for at least 3 months prior to becoming pregnant. Retinoids in the first trimester of pregnancy may be associated with neural tube defects in the growing baby, such as spina bifida and anencephaly. Oral retinoids are often prescribed for the treatment of acne, and topical retinoids such as retinol are often found in high end creams, serums and other beauty products for anti-ageing. It is also advised to avoid skin lightening agents including hydroquinone and alpha arbutin, and any products containing CBD. Salicylic acid is often discussed as an ingredient to avoid, however with individual guidance from a doctor it can be used topically in percentages up to 2%. Fragrances and alcohol in cosmetics are best avoided if you have any underlying skin sensitivity or redness. My advice would be to transition to a safe and effective skin care routine ideally before becoming pregnant. Always check product information on the back of your cosmetics for the inci (ingredients) list to be 100% sure of what you are using.

My advice would be to transition to a safe and effective skin care routine ideally before becoming pregnant. Thinking about body lotions and shampoo for the skin on your scalp and body is also a consideration, as these products will cover a large surface area of your skin. With the emergence of several safe yet extremely effective active ingredients, a lot of the routines I advise for women last during pregnancy and beyond.

My top 4 ingredients to use in during pregnancy are:

1. Alpha-Hydroxy Acids (AHAs). These acids act as chemical exfoliants – sloughing off the top layer of dead skin cells and increasing new cell turnover which helps even out skin tone, reduce blocked pores, and improve fine lines. Depending on which AHA there are additional benefits such as improving hyperpigmentation and increasing collagen and elastin production. Lactic Acid is a good AHA to use during pregnancy as it retains the most moisture in the skin comparative to other AHAs and is the least likely to irritate or dry. Incorporating your AHA into your cleanser with Cosmedix’s Lactic Acid Rx Cleanser is a great option.
2. Vitamin C. Vitamin C is a hero ingredient important whether pregnant or not, and luckily safe to use throughout your pregnancy journey. It is a potent anti-oxidant that increases collagen and elastin in the skin and inhibits the enzyme responsible for pigment production. Look out for stabilised vitamin C esters around 10% concentration to get the the full benefit.
3. Sunscreen. During pregnancy it is so important to be wearing SPF daily. From the first trimester there is an increase in potential pigment production owing to an increase in circulating oestrogen and progesterone. By the end of the third trimester this can lead to the development of melasma or the mask of pregnancy. Avoiding sun exposure and using SPF 50 will minimise this. During pregnancy mineral based sunscreens are preferred.
4. Azelaic acid. Perfect to help combat any pregnancy acne or blocked pores. Azelaic acid has powerful antibacterial properties that inhibit the bacteria responsible for breakouts and acne on the face. It prevents pores blocking through softening the top layer of skin cells and also provides an anti-inflammatory effect. I would recommend Dr David Jack’s Blue Face Peel containing Azelaic acid once a week. This is formulated with additional hyaluronic acid which will also help to plump and hydrate at the same time.

What products, treatments and active ingredients would you recommend for pregnant women who would like to eliminate wrinkles/reduce puffiness? 

Layering alpha hydroxy acids and vitamin C can effectively help treat fine lines during pregnancy. Lactic acid and glycolic acid are good options and depending on your experience with AHAs will depend on what concentration you can start off on and how to layer them. Look for a vitamin c at concentrations higher than 10%, and ideally in the active form l-ascorbic acid. The bespoke pregnancy facial at Dr David Jack’s clinic allows the use of a higher concentrations of pregnancy safe acids to help improve fine lines and brighten the complexion. The facial also includes lymphatic massage which is ideal for targeting puffiness. 

How to combat hormone induced acne/bacne during pregnancy?

Treatment of acne during pregnancy will depend on severity and whether this was something you suffered from prior to pregnancy. I would advise a consultation with a doctor specialised in pregnancy skincare early on. Under supervision from a doctor treatment with 15% azelaic acid with or without benzoyl peroxide has shown promising results. The added benefit of early effective treatment is minimising the risk of post-inflammatory pigmentation. For cases of inflammatory acne your doctor may recommend a pregnancy safe topical antibiotic.

Can stretch marks be prevented during pregnancy or are they largely genetic?

There is an element of genetic predisposition to stretch marks and given the amazing growth of your baby going on inside don’t be too disheartened if you get them. There are a couple of steps you can implement to try and minimize stretch marks. Research has shown daily massage with almond oil improves outcomes, alongside a healthy weight gain during pregnancy. If you are using an oil for massage, make sure the ingredients do not contain any retinols. If you do suffer from stretch marks, there are a number of in clinic treatments including carboxytherapy, resurfacing treatments and microneedling that are suitable after birth. Once you have completed your family you can introduce retinoids to help improve any remaining stretch marks.

How big a part does diet play on the skin condition during pregnancy?Are there any treatments that can help with skin laxity after pregnancy?

There is an incredible stretch of the skin during pregnancy so some skin laxity postpartum is definitely expected. Maintaining a healthy diet alongside prenatal supplements throughout pregnancy will no doubt help maintain the health of the skin too. The elastin properties in the skin do allow a degree of recoil following birth, however once you have completed your family it may be that a little help is required to improve the appearance of the tummy. The first step is to ensure the muscles underneath have returned to as close to the midline as possible to help minimise bulging. I would recommend seeing a pre and post-natal fitness expert who can help rehabilitate your core post pregnancy. I then treat the lax skin in clinic with Morpheus8 a specialist treatment

which involves a combination of radiofrequency and microneedling. This can help improve skin texture and tightness, and can also help improve scars from your C-section if you’ve had one.

Are there any treatments that could help me feel and look like myself again after pregnancy?

After birth there is a slow decrease in hormones and you can notice a decrease in collagen production. This coupled with lack of sleep can mean that your skincare routine needs adapting again to target more anti-aging concerns. You may also notice further changes in skin pigmentation, and it is important to maintain good SPF use. Adding in an ingredient to target pigmentation if not already in your pregnancy routine can be helpful. Treatments such as Lumecca IPL can help to treat residual hyperpigmentation post pregnancy, and collagen stimulating treatments such as Profhilo and Nucleofill can be good options to help the skin regain some of it’s ‘bounce’ and elasticity. Regular facials, such as our bespoke facial, can be excellent in restoring good surface texture to lacklustre skin.

Conclusion

With a bit of guidance most skin concerns should be able to be treated during pregnancy and the elusive pregnancy glow will remain ubiquitous. With the emergence of several great new products which use safe yet effective active ingredients a lot of the routines I advise for women last during pregnancy and beyond. Important for those women planning on multiple pregnancy or struggling over the years with fertility.

Dr Jo Mennie
MBChB MSc MRCS PhD
Aesthetic Practice at Dr David Jack Clinic, specialising in fertility, and pregnancy skincare.