“What products can I use on my skin during pregnancy and breastfeeding?” As a MotherToBaby information specialist answering our texting service, every day I get questions about any type of product you can think of that can be applied to your skin! Anything from itching and antibiotic creams, vitamin C products, essential oils, homeopathic creams and gels, acne products, to cosmetics and skin care products. Pregnancy and breastfeeding can be stressful times, and since we always want what is best for the baby, we all worry that a product we are using on our skin may get to the baby and be a problem. But is it true? What should you worry about and what can you use (as directed) without concerns?

Your Skin

First, lets talk about your skin and how topical products (things you put on your skin) get into your system. Your skin is a large, dynamic living tissue that is made up of different layers. We need to understand the absorption process in order to evaluate the safety of cosmetic, medicinal, and chemical products that come into contact with our skin. When a substance is put on your skin, it first has to go through the outer layer of the skin called the stratum corneum, which is made up of dead cells. Then come the living layers of our skin, the epidermis (waterproof barrier), dermis (connective tissue, hair follicles and sweat glands), hypodermis (fat and connective tissue) and the vascular network.

How Much is Absorbed?

Different factors affect skin absorption, including how much is applied, the physical state of the product (is it a liquid, powder, gel, etc.), where on the body it is applied, how large of an area the product is applied to, the person’s age, and whether the skin is wet or dry at the time the product is applied. Often, only 1 or 2% of an applied dose is absorbed into your system. But sometimes, more is absorbed, especially if your skin has open wounds, cracks etc. or if you have a skin condition such as eczema. In fact, how “complete” your skin is can be the most important factor in determining how effective a barrier it can be to topical products.

It can be hard to get good safety information on every type of topical product. The FDA (Food and Drug Administration) does require cosmetic products to be “safe,” which is based on their specific labeling and use. Yet cosmetic products do not need FDA approval to be sold on the market, and often the companies make claims that have not been studied and cannot be proven. So it is always a good idea to check with our MotherToBaby information specialists and let us research the product and its ingredients for you.

Many times during pregnancy and breastfeeding, people worry about the use of retinoids (a class of chemical compounds contained in treatments for acne, psoriasis, wrinkles, and other skin conditions), high dose salicylic acid (a common ingredient in topical acne treatments), formaldehyde (often used as a preservative in cosmetic products), hydroquinone (a skin-lightening agent that can be used to treat age spots and sun spots), and chemical sunscreens to name a few. These products do have some concerns and should be used with caution when pregnant and nursing.

Other products that are applied to your skin have less concerns in most instances. These include over-the-counter antibiotic creams, corticosteroid creams (used to reduce skin inflammation and irritation from things insect bites or poison oak/ivy, but also in treatments for eczema and psoriasis), essential oils, menthol and lidocaine type products (used in products to cool or numb the skin), hydrogen peroxide (used in treatments for acne, sun spots, and age spots), fluoride and dental products, homeopathic creams and gels, vitamin C products (used in treatments to reduce fine lines and as an antioxidant to protect the skin), and things that you put on your hair and nails.  

So that is the skinny on skin care! You might be able to use more products on your skin than you thought you could during pregnancy and breastfeeding. Even with a product that is considered low risk, you may want to check with your healthcare provider or with us if you have any concerns before using. We have a number of fact sheets and blogs that can answer some of your questions about topical products, and our information specialists are always happy to answer your questions by phone, text, email, or chat.

There are a variety of uses for botulinum toxin, marketed as Botox, that include both cosmetic procedures and treatment for some medical conditions. The experts at MotherToBaby get questions about the safety of being injected with Botox during pregnancy and breastfeeding. While more studies are  still needed, we can answer some of your questions with helpful information as you decide whether or not you feel comfortable using it.

What is Botox?

Botox and Botox Cosmetic are used by healthcare providers. Both include botulinum toxin, though each are used differently depending on what issue is being addressed. You may also see it called OnabotulinumtoxinA or botulinum toxin type A. This toxin works by paralyzing muscles at the site where it is injected, causing the muscles to relax.

There is an illness called botulism, which you may have heard of, and it is caused by the bacteria that make the botulinum toxin. According to the CDC, botulism is a rare but serious illness and can cause people to have vision or breathing issues, paralyzes muscles causing them to feel weak, and can cause death in some cases. It is often caused by bacteria associated with improperly canned or preserved foods and symptoms are likely to present 18-36 hours after eating the contaminated food. You can read more about the different types of botulism here.

What is Botox used for?

When used for cosmetic reasons, the botulinum toxin is injected into specific areas, like the face or neck, in order to smooth out wrinkles or lines in the skin.

There are also individuals who get Botox to help with medical conditions. Examples include treating chronic migraines, urinary incontinence (or issues with the bladder), and spastic muscle movements in parts of the body. Some people also get Botox injections to help stop excessive sweating in certain areas of their body. There are several uses for Botox, and some are incredibly important for improving quality of life and function for people.

What is known about being exposed to Botox during pregnancy or breastfeeding?

The short answer is not a lot. There have been no well-controlled research studies in either pregnant or breastfeeding people. Botox is expected to be contained to the area of the body where it is administered to and not to circulate throughout a person’s system. Because it is not known to enter your system, or bloodstream, it is unlikely it could cross the placenta to reach a developing baby or to enter breast milk. However, because we do not know for sure, many providers suggest avoiding using Botox during pregnancy and lactation. It is also thought to stay in your body from four to six months, so avoiding using it while planning a pregnancy if possible may also be advised. 

There are some risks that come with Botox use. It is possible to get an infection in the area where you are injected, and the toxin could spread beyond where it is injected. This can cause people to experience issues breathing and/or swallowing issues and seeking immediate medical care if needed is important.

Speaking with your healthcare provider is always recommended by the experts at MotherToBaby. If you are routinely receiving some form of Botox therapy, it may be worth discussing this with your healthcare provider before you become pregnant. Weighing the pros and cons of your therapy can help you make the best choice for yourself and your baby. If you are receiving Botox for purely cosmetic reasons, putting a pause on your injections may be well worth the wait if you want to take the least risk possible.

To read more from the Centers for Disease about botulism visit: https://www.cdc.gov/botulism/index.html

FDA Botox Drug Label: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5232lbl.pdf

A Special Edition Baby Blog in Partnership with SafetyNEST®

By Chris Stallman, Certified Genetic Counselor at MotherToBaby Arizona and host of  The MotherToBaby Podcast

As a teratogen information specialist, one of the questions I frequently get asked is “can this product be harmful to me or my pregnancy?” What a perfect time to address this question during June’s National Safety Month, which aims to raise awareness about reducing the leading causes of unintentional injury in the home! What is the answer to that common safety question? Usually yes, a product can be harmful to you or your pregnancy. But before you throw out everything in your house and live in a bubble for nine months, let me explain…

Anything can be toxic if too much is ingested or absorbed into the body – even water. What matters is the dose – how much of something you are exposed to. For example, in a healthy person, drinking 8-10 glasses of water a day would not be expected to cause water toxicity. However, drinking 8-10 gallons can be dangerous. Again – all in the dose.

There may be beauty products you use before pregnancy that may not be recommended for use during pregnancy. We’ll look at a few common products below:

Retinoids

When it comes to treating acne outside of pregnancy, there are many options. Vitamin A (retinol) and vitamin A derivatives (such as retinoic acid and isotretinoin) are often referred to as “retinoids”, and can be found in some acne treatment products. It’s well-known that the drug Accutane® (a pill taken by mouth that contains isotretinoin) can cause birth defects in pregnancy, but it’s less clear if topical retinoids (like gels or creams) have the same effects. When applied on the skin, usually much less of the medication makes it into the bloodstream. This means less of the medication would make it across the placenta to the fetus. However, even though the risk with topical use is different than when taking a pill, women who are pregnant, planning to become pregnant, or breast-feeding should discuss this with their healthcare provider.

Salicylic acid

This relative of aspirin can be found in some beauty products, including cleansers and toners.  Low dose aspirin (less than 81 mg/day), taken by mouth, has been well studied in pregnancy and does not appear to increase the chance of birth defects or other pregnancy complications. When applied on the skin, the amount of salicylic acid that enters the body would be much less than when a woman takes low dose aspirin. The amount that can be absorbed depends on the health of the skin, the levels (dose) of active ingredients, the area exposed (how much skin comes in contact with the product) and how often you use it. It’s important to use as directed by the product label or by your healthcare provider. When used as directed, it is unlikely that topical salicylic acid would pose any risk to a developing baby. Too much of this ingredient can cause symptoms such as nausea, vomiting, dizziness, headache, problems with breathing, abnormal heart rhythm or coma, and can be fatal.

Hair dye

In general, when used as recommended, the amount of dye that is absorbed by the healthy skin of the scalp is small and is not expected to cause problems in a pregnancy. However hair products made outside of the US might have dangerous substances or contaminants such as heavy metals, including lead, cadmium, nickel, arsenic or mercury. So it may be best to avoid beauty products made in other countries. Gloves should be worn to protect the skin on your hands, although this does not protect the scalp, neck, forehead, ears, and eyelids. If a temporary dye gets into your eyes, minor irritation is expected. For semi-permanent and permanent dyes, effects on the eyes can be more serious, which is why it is recommended that these products are not to be used to dye eyebrows or eyelashes. If eaten (ingested), effects can be minor irritation of the mouth, nausea, vomiting, allergic reactions, and possibly chemical burns. It’s best to keep these (and all) products out of the reach of children, and to wash any areas of the skin where dye was present.

So, can beauty products be used in pregnancy? Absolutely, depending on the specific ingredients, how much you use, and how often you use it. When in doubt, ask a professional.

If you suspect you had a toxic exposure to a product, call Poison Control at 1-800-222-1222. If you have questions about everyday exposures during pregnancy or breastfeeding, call MotherToBaby at 1-866-626-6847.

Chris Stallman is a certified genetic counselor based in Tucson, Arizona and proud mother of three. She is the new host of The MotherToBaby Podcast, a show answering moms’ questions with evidence-based answers about exposures during pregnancy and breastfeeding. Listen to the episode on beauty products in pregnancy and breastfeeding on iTunes, Google Play Music or Spotify. She currently works for The University of Arizona as a Teratogen Information Specialist at MotherToBaby Arizona, formerly known as the Arizona Pregnancy Riskline. Her counseling experience includes prenatal and cardiac genetics. She has also served as MotherToBaby’s Education Committee Co-chair.

About MotherToBaby 

MotherToBaby is a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets. Also, make sure to subscribe to The MotherToBaby Podcast available on iTunes, Google Play Music, Spotify and podcatchers everywhere.

 

By Robert Felix, President, MotherToBaby

Gardens are blooming, kids are out of school, beaches and parks are crowded, and the sun is shining. Ahhh….Summer is here again! With more skin showing during these warm summer months, it’s important to protect our skin from the sun by wearing sunscreen. But what do we know about the safety of sunscreen products during pregnancy? Should pregnant moms avoid sunscreen? What if the day is overcast and cloudy? These are questions I’m getting often these days as a teratogen information specialist at MotherToBaby. So let me share with you what I tell women who contact our service…

First, there’s a misunderstanding that when the sun is not directly shining, like when it’s overcast, we are protected from the harmful effects of the sun’s ultraviolet rays (UV-A and UV-B). So let me shine a light on the issue (no pun intended). Because the sun’s ultraviolet rays penetrate clouds, everyone – including children and pregnant women – is vulnerable to sunburns, even on cloudy days. Damage to our skin that is caused by the sun can lead to long-term issues, including premature aging as well as skin cancer.. Prevention is key. Seeking shade, wearing protective clothing and using sunscreen are all important in reducing the risk of sunburns and skin cancer.

So what about sunscreen safety during pregnancy?

Sunscreen alone is not fully protective. However, it certainly can provide added protection for the skin and reduce the risk from sunburn. In fact, the American Academy of Dermatology (AAD) recommends everyone use sunscreen. Pregnant or not, choose a sunscreen that protects against both UVA and UVB rays. Water resistant with a high sun protection factor (SPF) really helps, too; the AAD recommends using a sunscreen with a SPF of at least 30, which blocks 97% of the sun’s rays.1

The ingredients in sunscreen products in the U.S. have to go through a specific approval process. They must be reviewed by the U.S. Food and Drug Administration (FDA) for their safety before they hit shelves. Unfortunately, there is not one preferred choice for pregnant women. However, it is reassuring that to date there is no published information suggesting that sunscreens cause an effect to the developing fetus/unborn baby. Additionally, sunscreen use can help prevent blistering sunburns, which can become easily infected and lead to other complications for a pregnant woman.

So what do our counselors at MotherToBaby recommend that pregnant women do? Before you head out the door, cover up with cool, breathable long sleeve clothing; wear a hat to protect your head and face; apply sunscreen on any areas of your skin that are exposed; and try to stay under shaded areas, when possible. Our last bit of advice? Enjoy your summer!

Robert Felix is a teratogen information specialist at MotherToBaby California, a non-profit affiliate of the international Organization of Teratology Information Specialists (OTIS). Robert is the current president of MotherToBaby and is based at UC San Diego’s Center for Better Beginnings. MotherToBaby CA answers questions over the phone as well as via live chat and email through www.MotherToBabyCA.org.

MotherToBaby is a service of the international non-profit Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies, including the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration’s (FDA) Office of Women’s Health. If you have questions about medications, diseases, vaccines or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit www.MotherToBaby.org to browse a library of fact sheets and to find your nearest affiliate.

References:

1. American Academy of Dermatology. Suncreen FAQs. Available from, https://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreen-faqs Accessed July 6, 2015.