In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. This sheet talks about whether exposure to tretinoin may increase the risk for birth defects over that background risk. This information should not take the place of medical care and advice from your health care provider.

What is tretinoin?

Tretinoin is a chemical that is applied to the skin to treat acne and other skin problems. Brand names for tretinoin include Atralin®, Avita®, Retin-A®, Renova® and Tretin-X®. Tretinoin belongs to a group of medications called the retinoids; all of these medications are related to Vitamin A which is required in small amounts for normal development. Other medications in the retinoid family are isotretinoin (Accutane®), acitretin (Soriatane®) and adapalene (Differin®).

My health care provider said that tretinoin is like isotretinoin, and I’ve heard that isotretinoin causes birth defects. Can using tretinoin during pregnancy cause birth defects?

When women take isotretinoin in the first 12 weeks of pregnancy, certain birth defects can occur. For this reason, health care providers recommend that women not take isotretinoin during pregnancy. Isotretinoin, however, is taken by mouth. It enters the mother’s bloodstream and is then passed on to the baby.

Tretinoin, because it is applied to the skin (topical), is different. Low amounts of tretinoin pass through the skin into the mother’s bloodstream, and even less reaches the baby. Broken skin, using more than is needed on an area, or use on a large area will cause more of the tretinoin to pass through the skin. In general, the less tretinoin that is used on the mother’s skin, the less likely there will be risks to the baby.

I have acne. Can I use tretinoin while I’m pregnant?

Several studies have tried to find out the effects of tretinoin on pregnancy. These studies have not found that babies whose mothers used tretinoin during pregnancy are any more likely to have birth defects than babies whose mothers did not use tretinoin.

There have been four reports of babies born with birth defects after their mothers used tretinoin during pregnancy. Usually, a few reports do not cause health providers to worry, but the birth defects reported in these four cases are like the defects seen in babies whose mothers took isotretinoin during pregnancy. Since tretinoin and isotretinoin are related, it is possible that these two medications can affect the baby in the same way. Because many women use tretinoin during pregnancy and there are only these four reports, the risk for the same kinds of birth defects is probably low. However, it is generally recommended not to use tretinoin in pregnancy due to the possible risks.

I am using tretinoin now, but would like to stop using it before becoming pregnant. How long should I wait after I stop using it before I try to get pregnant?

Tretinoin stays in the body for about one week after you stop using it. The makers of isotretinoin suggest that women stop using it one month before trying to get pregnant. Based on this suggestion for isotretinoin, a safe approach would be to stop using tretinoin one month before trying to get pregnant.

If I stop using tretinoin in the first trimester, is it okay to start using it again in the last two trimesters of my pregnancy?

During the first three months of pregnancy, the baby’s organs are forming. In months four through nine, the baby’s body and brain are growing. Because the organs form in the first trimester, tretinoin use in the second and third trimesters is unlikely to cause a birth defect. However, because no studies have been done to look at tretinoin’s effect on the brain of children as they get older, avoiding this product may be safest.

Can I use tretinoin while I am breastfeeding?

When used on your skin, it is known that very little tretinoin passes into your body, and so the amount in breast milk would probably be very little to none. Tretinoin use during breastfeeding has not been studied. However, a related medication (acitretin) has been studied and is rated by the American Academy of Pediatrics as usually compatible with breastfeeding. You may wish to talk to your health care provider about any concerns you have with use of this medication while breastfeeding. Be sure to talk to your health care provider about all your options for breastfeeding.

What if the father of the baby uses tretinoin?

There are no studies looking at possible risks to a pregnancy when the father uses tretinoin. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures and Pregnancy at http://www.mothertobaby.org/files/paternal.pdf.

Selected References:

  • AAP Committee on Drugs. 2001. The transfer of drugs and other chemicals into human milk. Pediatrics 108:776-789.
  • Camera G and Pregliasco P. 1992. Ear malformation in baby born to mother using isotretinoin cream. Lancet 339:687.
  • Giagounidis AAN, et al. 2000. Acute promyelocytic leukemia and pregnancy. Eur J Haematol 64:267-271.
  • Hale T. 1999. Medications and Mother’s Milk, 8th ed. Amarillo, TX: Pharmasoft Medical Publishing, pp 689-690.
  • Jick S, et al. 1993. First trimester topical tretinoin and congenital disorders. Lancet 341:1181-1182.
  • Loureiro KD, et al. 2005. Minor Malformations Characteristic of the Retinoic Acid Embryopathy and Other Birth Outcomes in Children of Women Exposed to Topical Tretinoin During Early Pregnancy. American Journal of Medical Genetics 136A:117-121.
  • Lipson AH, et al. 1993. Multiple congenital defects associated with maternal use of topical tretinoin. Lancet 341:1352-1353.
  • Ross SA, et al. 2000. Retinoids in embryonal development. Physiol Rev 80(3):1021-1054.
  • Selcen D, et al. 2000. Otocerebral anomalies associated with topical tretinoin use. Brain Dev 22:218-220.
  • Shapiro L, et al. 1997. Safety of first trimester exposure to topical tretinoin: prospective cohort study. Lancet 350:1143-1144.