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Retinoids is an umbrella term for vitamin A derivatives that treat all manner of skin concerns from acne to wrinkles, fine lines and pigmentation.
“They’re pretty much the gold standard skincare ingredients because they work for so many things,” says Michelle Wong, a chemist and science communicator based in Sydney.
Retinoids come in different forms.
The most potent are prescription-only acne treatment drugs such as isotretinon, which is taken orally, and tretinoin which is applied to the skin to treat severe acne.
Then there are pharmacist-only products containing adapalene, and a range of “over-the-counter” retinoids such as retinal and retinol which are in topical creams applied to the skin at much lower concentrations.
It’s widely accepted that oral retinoids are not safe for pregnant women and may cause birth defects — and that is labelled clearly on the packaging and drug information leaflets. Prescription-only and pharmacist-only topical retinoids also carry warnings.
But what about over-the-counter (OTC) topical retinoid products?
Confusing advice for pregnant women
NSW Health’s Mothersafe, a service for mothers run by NSW Health, says OTC creams are safe for pregnant women to use because they are applied topically and contain smaller doses, but advises against the use of prescription topical treatments.
“Looking at standard retinol products on the market, it should be safe for pregnancy, as long as people are not using it in weird ways,” she says.
But many health practitioners advise against using any type of topical retinoid.
Laura Gerhady, a maternal fetal medicine specialist who studies the effects of medication in pregnancy says there is insufficient research to make clear determinations for the use of topical retinoids during pregnancy.
“Part of that is because most people using topical retinoids will be using them for conditions that are not vital to treat during pregnancy, things like acne.”
There are no mandatory standards for labelling cosmetic skincare products containing retinoids such as retinal and retinol. The only non-prescription topical products that require labelling are those containing adapalene. These products were recently downgraded from prescription-only and made available as behind-the-counter products in pharmacies.
Gerhardy says there isn’t clear labelling because there isn’t a specific guideline on what is and isn’t safe.
“For [all] topical retinoids, the message is that we don’t have great information, but if you use it, it’s probably fine.
“To communicate that in a single sentence on packaging is quite difficult. It is straightforward with oral retinoids — they are certainly harmful in pregnancies.
“But topical is more challenging because we just don’t have the data,” she says.
As research about both prescription and OTC topical retinoids is limited, guidance from health practitioners is typically interchangeable.
Deshan Sebaratnam, a dermatologist at Liverpool Hospital says he advises his pregnant patients to avoid using all retinoids — including retinol — as a precaution.
“Much like alcohol, the safest choice would be to avoid retinol in pregnancy but the absolute risk is low,” he says.
Likewise, the American College of Obstetricians and Gynaecologists says that even though the amount absorbed by the body is low, neither prescription nor OTC products are recommended.
What happens if you accidentally use a topical retinoid while pregnant?
Wong says pregnant women who may have used topical retinoids without knowing should not be alarmed.
“Topical retinoids are generally not recommended during pregnancy but it’s not worth panicking about if you accidentally use it once or twice,” she says.
“If applied topically, the amount of product that would enter your system would be quite low.
“Including from prescription creams,” she says, but adds: “There’s still a hierarchy of risk though. For example, tretinoin is the riskiest one.”
A large Nordic study published last year found that while the use of topical retinoids had significantly increased over the past 20 years, there was no evidence of increased risk of birth defects in babies exposed to topical retinoids during pregnancy.
While the authors say those findings are “the strongest evidence to date on the safety of topical retinoids during pregnancy”, they also acknowledge their study may underestimate the risk and more research is needed.
If you are thinking about using topical retinoid products, speak to your healthcare practitioner for advice.
Other skincare ingredients to look out for
Sebaratnam recommends avoiding minoxidil (a hair growth formula) and hydroquinone, which treats dark spots.
“Most other over-the-counter beauty products are probably safe,” he says.
“But mums need to weigh up whether they really need to be using them or not.”
Other products Wong recommends watching out for are online products that might be unregulated or high doses of salicylic acid, a cleanser that is also a chemical exfoliator.
Mothersafe NSW says salicylic acid is safe for use in smaller doses, however “quantities of salicylic acid absorbed may be higher in specific situations so safety of use should be confirmed with MotherSafe or your healthcare provider”.
Wong also cautions against using beauty products bought online that don’t have verified information.
“I would be cautious about those sorts of products that are really cheap and too good to be true,” Wong says.
For most pregnant women, the safest approach is to stick with simplicity; use well-regulated products, and speak to your healthcare practitioner.
