Lessons In Pregnancy Skin Care

The surge of hormones that pregnancy brings can manifest itself on the skin in a variety of ways. A major one, says New York dermatologist Dr. Macrene Alexiades, is melasma, the hyperpigmentation known more ominously as the mask of pregnancy. “What makes it the biggest problem is the fact that it’s intractable, so it typically doesn’t go away after you give birth. You’re limited in the ingredients that are safe to use to treat it during pregnancy,” she explains. Increased dryness, which can result in more overall sensitivity, is another issue, says Dr. Shereene Idriss of Union Square Laser Dermatology. “And the increased blood volume that pregnancy brings, along with an increase in estrogen levels, can also result in more redness,” adds Idriss. And, of course, there’s acne. Considering how hormonally driven acne can be and the drastic changes happening in your hormonal milieu during pregnancy, it’s a less surprising—although no less annoying—skin side effect. “I never had acne growing up, and when I got pregnant I suddenly had breakouts,” shares Vicky Tsai, founder of Tatcha (the entire line is formulated to be pregnancy safe). But here’s one upside: “People who typically have very bad acne before pregnancy tend to clear up,” says Alexiades.

The FDA has a system in place to organize ingredients into categories of safety using letters of the alphabet: A, B, C, D, and X. A and B get the green light during pregnancy, C means there’s possible risk to the fetus, and D and X are completely off limits. Consumers still have to do a lot of the legwork (read: scrupulous label reading), however. “The law doesn’t require cosmetic products or ingredients to have FDA approval, so it’s the responsibility of the company that manufactures or markets the product to make sure it’s safe,” says Idriss. “That’s why, when it comes to pregnancy, it’s extremely important that you’re educated on what you apply to your skin.” With her patients, Brooklyn-based certified nurse midwife (and cofounder of natural skincare line Sisters Body) Jo Zasloff likes to start with a few general rules. “I always recommend staying away from anything with sulfates, parabens, silicones, and synthetic fragrances because all these ingredients can coat the skin and inhibit the body’s microbiome from thriving,” she explains. Here, the primary ingredients that you should bid farewell (for a while, at least) and ideas on what you can swap them for.

Retinol / Retinoid / Vitamin A

Any vitamin A derivative works wonders on the skin as an anti-aging ingredient. While the FDA classifies this group as a C, dermatologists will tell you to shelve these products for the duration of your pregnancy and while breastfeeding. “High amounts of vitamin A have been shown to cause birth defects, and the potential for topical vitamin A to be absorbed systemically through the skin may also interfere with fetal development,” says Idriss. Same goes for oral dosages of vitamin A, especially Accutane, which is teratogenic and has been directly linked to birth defects. In place of a retinoid, Tsai likes to recommend natural ingredients like Japanese Angelica root or vitamin C, the antioxidant whose collagen- and glow-boosting capabilities are a boon, regardless of whether you’re pregnant. Another option: beta carotene. “You can consider beta carotene your primary source of vitamin A. Look for carotenoid-rich oils like carrot seed or rosehip seed oil,” says cosmetic chemist and skincare brand founder Marie Veronique. Or you can get the benefits via beta-carotene–rich foods like carrots and orange squash, both of which are loaded with the stuff.

Salicylic Acid

Don’t cringe at the mention of every acid; you only have to avoid some. Chief among those: beta hydroxy acids—especially salicylic acid, which is sneaking into many products nowadays. Topically, salicylic acid is found in aspirin and even Pepto-Bismol. “When salicylic acid is taken orally in aspirin form,” says Idriss, “studies have shown that it’s contraindicated and may lead to preterm birth, low birth weight, or other malformations.” Even though absorption of salicylic acid through the skin can vary, it’s best to play it safe, especially because there are so many alternatives. “If you’re using salicylic acid to control acne or are experiencing breakouts, switch to lactic acid. This has the added benefit of stimulating the biosynthesis of glycosaminoglycans like hyaluronic acid, so it keeps skin beautifully plump and hydrated,” says Veronique. Products with hyaluronic acid are AOK, as are glycolic, mandelic, and azelaic acids. If you want a fail-safe alternative for a favorite salicylic acid wash, try yogurt. “Yogurt is the absolute safest for cleansing and moisturizing,” says Veronique. “It also contains live bacteria to balance the skin’s microbiome. And for an extra bonus,” she adds, “look for Streptococcus thermophilus on the yogurt label ingredient list. This little hero stimulates ceramide production in the skin.”

Benzoyl Peroxide

Another acne fighter that’s a no-go is benzoyl peroxide. Alhough the FDA lists the oft-prescribed medication as a C (meaning risks are possible, but not presumed) and, according to Idriss, less than 5 percent is absorbed through the skin, there are better options. For her patients with acne, Alexiades presents options like azelaic acid, topical erythromycin, clindamycin, or topical sulfur. And Veronique recommends steering clear of benzoyl peroxide regardless of whether you’re pregnant because of the side effects on the skin when it’s used long term. “It damages the moisture barrier and acid mantle; causes dry, cracked, red, and irritated skin; disrupts skin’s microbiome; bleaches the skin, causing sun sensitivity; and accelerates premature skin aging by increasing reactive oxygen species in the skin,” she says. To fight an inflammatory condition like acne, she suggests balancing the microbiome with probiotics, taken orally and applied topically.

Hydroquinone

No matter how frustrated you are by hyperpigmentation, the potent skin brightener hydroquinone—which is widely used clinically—poses a risk, even in the lowest concentrations. Veronique’s favorite alternative is a classic: vitamin C. “When ascorbic acid and its derivatives are used in a good formulation, it decreases melanin synthesis by inhibiting tyrosinase, the enzyme that triggers melanogenesis,” she explains. For optimal effect, she advises looking for vitamin C derivatives like magnesium ascorbyl phosphate, ascorbyl glucoside, and tetrahexyldecyl ascorbate, and, if possible, skipping vitamin C in powder form. “These powders crystallize on the skin, and their exfoliant properties may compromise skin’s protective barrier and increase sun damage risk, thus causing more rather than less hyperpigmentation in the long run,” she adds.

Essential Oils

While essential oils are found in many products and often assumed to be completely harmless, some are being singled out as problematic during pregnancy, although more research is required. “It’s slightly controversial because of the lack of studies available and because the percentage and concentration of each ingredient can vary dramatically from brand to brand,” Idriss notes. “But certain oils in particular can lead to pregnancy complications like premature uterine contractions.” Two that Alexiades advises her patients to dodge: rosemary oil and tea tree oil. “All plant extracts and essential oils hold problems for fragrance-sensitive people and every individual reacts differently, but there’s no hard-and-fast rule that can predict who will react to what, so it’s best to avoid all of them for the short term. That goes for aromatherapy, too,” adds Veronique.

While sunscreen is always advised, it’s especially critical during pregnancy. “Your skin is much more sensitive to the rays of the sun, plus your pigment-producing cells go into overdrive, making you more prone to hyperpigmentation and skin cancer,” says Idriss. The type of sunscreen you use is also important. Chemical sunscreens may have ingredients like oxybenzone (linked to premature birth weight) and benzophenone (linked with endocrine disruption), plus phthalates, parabens, and salicylates. Ditch these completely in favor of a mineral variety. But Alexiades cautions against using micronized mineral sunscreens. “You want mineral blocks that don’t fall into the nano-size particle category because these can seep into your bloodstream,” she says. “Just because it’s not a chemical doesn’t mean that it’s safe.” If you’re feeling confused by your options, buy a sunscreen made for babies by a well-known brand; they are usually rigorously tested for safety.

If you’re someone who, prepregnancy, had a standing appointment at the dermatologist for peels, Botox, fillers, laser treatments, and so on, you will have to earmark that time differently. Most dermatologists, Idriss and Alexiades included, will limit treatments for pregnant patients to glycolic or fruit acid peels, and completely eschew Botox, fillers, and anything involving laser. “Given that your skin is much more sensitive during pregnancy, your risk of burning during an IPL is higher,” says Idriss. “A Clear and Brilliant treatment isn’t necessarily going to harm your pregnancy, but there is the potential risk that a complication may occur, so I’m very conservative with pregnant patients.” Idriss will treat certain patients with lasers and fillers while they’re breastfeeding, but avoids Botox until they’re weaning. If you feel like your skin needs an extra boost, try giving yourself an at-home gua sha facial massage with oil to help lift and tone.

“Pregnancy is already hard on your immune system, so it’s really important to eat a well-rounded diet, drink lots of water, and get enough sleep to allow good bacteria and peptides on your skin and hair to thrive,” says Zasloff. Staying hydrated is crucial and will translate to less irritation and dryness, so drink and eat your water in the form of moisturizing food like cucumbers. Veronique also loves making food that can also moonlight as face masks. “For dry skin, make avocado toast and reserve some of the mashed avocado to apply to the face,” she says. “Potato has catecholase, an enzyme that helps lighten skin, and sour cream and yogurt have lactic acid, another good skin lightener. When you bake a potato, reserve part of it to mix with some sour cream or yogurt. Put on skin for 15 minutes and rinse.” For breakouts or blotchy skin, it’s all about soothing ingredients like honey and oatmeal. “Honey is antibacterial and oats have incredible anti-inflammatory properties,” says Veronique. “I make oatmeal and sweeten with honey and add almond milk to taste, then reserve a bit to put on my face for 15 minutes when it cools off.”