“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.

Concerned about medication use during pregnancy? You’re not alone. 
In this episode of The MotherToBaby Podcast, host Chris Stallman, MS, CGC (genetic counselor, mom of four, teratogen information specialist) sits down with Dr. Judy C. Morrow of Harvard Medical School to break down how FDA REMS (Risk Evaluation and Mitigation Strategy) programs help reduce the risk of birth defects and protect pregnant patients.

Together, they discuss:
✔️ What REMS programs are and why they exist
✔️ How REMS programs support safe medication use
✔️ The role of manufacturers, prescribers, and pharmacists
✔️ Common medications with REMS programs (including isotretinoin/Accutane)
✔️ Pregnancy testing requirements & pharmacy restrictions
✔️ Why some drugs don’t have REMS (even if risks exist)
✔️ What patients should ask if they’re prescribed a REMS-covered medication 

Dr. Morrow shares how researchers use real-world data to identify medication-related adverse events in pregnancy, how REMS programs try to prevent exposed pregnancies, and why communication between patients, providers, and pharmacists is essential. 

If you’re pregnant, planning a pregnancy, breastfeeding, or support patients in these settings, this episode offers clear, practical insights to help guide informed decision-making.

🔎 Key topics: pregnancy, REMS, FDA, teratogens, isotretinoin, Accutane, birth defects, pharmacy programs, medication safety, pregnancy data, registries

🎧 Listen now to learn how REMS programs help protect pregnant women and their babies.

The arrival of spring and summer warmth spurs many of us to spend more time outdoors and make travel plans, be it for a honeymoon, babymoon, or other seasonal getaway. Such was the case with Yesenia, who contacted MotherToBaby with questions about her upcoming summer vacation after finding out she is pregnant. Yesenia knew that with warmer temperatures comes an increased chance of mosquito bites and the infections they can carry. Like Yesenia, as you engage in more outdoor activity and plan getaway time, you may also have questions about exposure to these infections and their possible effects on a pregnancy. Understanding the potential risks of these illnesses and ways to protect yourself may help you make better-informed decisions before you decide to travel. This month, MotherToBaby turns to our partner the Society for Maternal-Fetal Medicine (SMFM) to help answer some of Yesenia’s questions:

What are vectors and vector-borne illnesses?

Vectors are living organisms, such as mosquitoes, ticks, biting flies or fleas, that are capable of spreading diseases to humans through bites and other forms of contact. Some common examples of these diseases, called vector-borne illnesses, include Chikungunya, dengue, malaria, Oropouche, and Zika virus. While disease-carrying insects can bite year-round, they are most active during warm weather. Many vector-borne illnesses have no cure, and treatment is usually limited to just managing the symptoms. This is why it’s important to protect yourself from bites!

How can vector-borne illnesses affect a pregnancy?

There can be serious health complications for the mother with some vector-borne infections during pregnancy, such as severe anemia, bleeding, and the need for hospitalization. If the mother develops serious complications, it increases the chance of problems for the baby, such as low birth weight, preterm delivery, or stillbirth. Some vector-borne illnesses may be passed from mother to baby during pregnancy, which can lead to serious birth defects, such as microcephaly (a condition where the head is smaller than normal), other structural defects of the brain and eyes, and problems with long-term development and cognition (such as learning, understanding, and memory). For more information, see the MotherToBaby fact sheets on dengue, malaria, Oropouche, and Zika. The CDC also has information about chikungunya and other vector-borne diseases.

I am pregnant and I am planning to travel. How can I protect myself?

Here are some quick tips:

• If traveling, check CDC’s Travel Health Notices (THN) page before booking your trip. Avoid nonessential travel to high-risk areas starting with a Level 2 or higher advisory on the THN board.
• Use the Travelers’ Rapid Health Information Portal for destination-specific recommendations, such as which vaccines to get to prevent travel-related illness.
• Wear long-sleeved shirts and long pants when spending time outdoors.
• Apply Environmental Protection Agency (EPA) registered insect repellents to exposed skin and clothing.
• Avoid outdoor activity during dusk and dawn when mosquitoes are most active.
• Minimize exposure to open water sources, such as pools and lakes, which are breeding grounds for vectors.
• Keep windows and doors closed or use fans, mosquito nets, and mesh screens on windows and doors.
• Use the CDC’s Pregnant Travelers’ Health Guide for other general travel tips.

Which insect repellents are EPA-registered? And are they safe for me to use during pregnancy?

EPA-registered insect repellents include:

• N, N-diethyl-meta-toluamide (DEET)
• Picaridin
• IR3535
• Oil of lemon eucalyptus
• Para-menthane-diol

The EPA has studied these insect repellents for their effectiveness and safety profile. When used as directed on the product label, there is no evidence to suggest that these insect repellents increase the chance of birth defects or other pregnancy-related complications. For additional information, please see the MotherToBaby fact sheet on insect repellents.

Are there alternative insect repellents I can use?

Other essential-oil-based insect repellent products, including disposable wristbands and patches, are often advertised as safer alternatives to EPA-registered products, but there is no scientific evidence that they effectively protect you and your baby against disease-carrying insects. In addition, the essential oils in these products, such as peppermint, citronella, and lemongrass, are not regulated by the EPA as pesticides. It’s better to steer clear of these products in favor of EPA-registered insect repellents.

I’ve read about “parasite cleanses.” Do they work on vector-borne illnesses?

Parasites are living organisms that live on or inside a host and can cause harm by damaging tissues or triggering severe immune responses. Vector-borne illnesses are different from parasitic infections. But you may have seen social media posts touting home parasite cleanses that claim to “detox the body” and “kill off parasites” and wonder whether they could help prevent these diseases. The answer is a decided “no.”

These cleanses, which contain a blend of herbs, have no proven record of efficacy (doing what the label claims they do) or safety (that they will not cause unwanted symptoms), especially for use during pregnancy. Although many of these products claim to target a wide range of parasites, they can have dangerous and unknown side effects for you and your baby.

Parasitic and vector-borne illnesses are serious conditions requiring proper medical attention. They cannot be cured by these products. If you suspect that you have a parasitic infection—or any other serious illness—it’s important to speak with a doctor as soon as possible, especially during pregnancy.

The bottom line

So, what’s SMFM’s advice to Yesenia for her upcoming travel? The bottom line for protecting herself this spring and summer from vector-borne illnesses: stay away from higher-risk areas, stick with proven, safe repellents recommended by the EPA, and get in touch with her healthcare provider if she has any questions. Safe travels to Yesenia and to you!

More about Our Guest Co-Authors from SMFM

Naima T. Joseph, MD, is Vice Chair of the Society for Maternal-Fetal Medicine (SMFM) Committee on Infectious Diseases and Emerging Threats. Dr. Joseph is an MFM subspecialist in the Department of Obstetrics and Gynecology at Boston Medical Center and an Assistant Professor at Boston University School of Medicine.

Hazel Salvador is an intern at the Society for Maternal-Fetal Medicine and a Master of Public Health (MPH) student at George Washington University. She is interested in health policy, maternal and child health, and epidemiology, and she hopes to pursue a Doctor of Public Health (DrPH) degree in the future. In her free time, she enjoys traveling and playing with her two parrots.

By Robert Felix, MotherToBaby Past President

I’ll never forget the panic in her voice. “The web said, ‘stay away from cats when you’re pregnant because your baby can be mentally retarded!” It was the first thing this soon-to-be mom could get out the second I picked up the phone. “It is true? I got rid of my cat immediately because I was so worried and I feel terrible about it,” she breathlessly explained. As a teratogen information specialist (someone trained to answer questions about exposures during pregnancy and breastfeeding), I knew her concern was shared by many. She was worried about something called “toxoplasmosis,” and after calling her doctor’s office, a nurse she spoke with didn’t say much or educate her about the infection. The nurse just reaffirmed that by getting rid of her cat, she had done “the right thing.” She was beyond frustrated. Not to mention, she missed her family’s feline!

After hearing her frustration, I asked her some basic questions relative to the cat.
• How long has she had the cat?
• Was the cat only indoor, outdoor, or both?
• Did she feed the cat any raw meat?
• Who changed the cat litter?
• Did she do any gardening?

Based on what she described, there was nothing to indicate that she was at an increased risk. “But I’m sure I’ve harmed my baby,” she said anxiously. So, I broke down the basics about toxoplasmosis. January is Birth Defects Prevention Month, what better time to revisit facts about infection?

Toxoplasmosis infections can occur by eating undercooked, infected meat, or handling soil or cat feces that contain the parasite. Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii. Although most adults have no symptoms, swelling of the lymph nodes, fever, headache or muscle pain may be seen. In most cases, once a person gets toxoplasmosis, he/she cannot get it again. About 85% of pregnant women in the United States are at risk for toxoplasmosis infection.

Women who have recently gotten a cat or have outdoor cats, eat undercooked meat, garden, or who have had a recent mononucleosis-type illness are at increased risk. In Europe where far more undercooked meat is eaten, there is a higher prevalence of toxoplasmosis. Toxoplasma gondii can be found in raw or undercooked meat, raw eggs and unpasteurized milk. Cats that eat raw meat or rodents can become infected, and the parasite lives in the cat’s feces for two weeks. Toxoplasma gondii eggs can live in cat feces buried in soil up to 18 months.

To avoid infection:
• Cook meat until it is no longer pink and the juices run clear.
• Wear gloves while gardening.
• Wash all fruits and vegetables.
• Wash hands carefully after handling raw meat fruit, vegetables, and soil.
• As for furry friends… Pregnancy’s not the time to be on litter box duty, but is a good time to get your partner to do it for you!
• Also, don’t feed cats raw meat.

Taking simple precautions to avoid infection during pregnancy will keep you healthy and keep kitty from landing in a homeless shelter. In addition, it’s very important for women to get prenatal care, talk to their healthcare providers, eat healthy and take their prenatal vitamins (including folic acid) during pregnancy. Remember, #Prevent 2Protect.

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 past president of MotherToBaby and is based at UC San Diego’s Center for Better Beginnings.

MotherToBaby is a service of OTIS, a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about toxoplasmosis, please visit our toxoplasmosis fact sheet, 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.

Stay Connected, Stay Current with MotherToBaby

If you’re looking for the latest news about exposures during pregnancy and breastfeeding or if you’re looking for a MotherToBaby expert who can provide you with information for your news story, you’ve come to the right place! Read on for information about our quarterly e-newsletter, our latest press releases, and how members of the news media can connect with one of our experts.

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Here’s the latest news distributed by MotherToBaby including exposure findings, research opportunities, organization announcements, educational and professional development opportunities, and birth defects prevention campaigns.

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MotherToBaby experts are available for news media interviews on many relevant issues related to pregnancy and breastfeeding exposures. From COVID-19 to the Zika virus, marijuana to mental health, alcohol to asthma, and so much more, our specialists have lent their expertise to news stories about the hottest topics that impact pregnant and breastfeeding women and their babies. Please see our Media Requests page for information on getting in touch with our experts for interviews, speaking engagements, and help with stories.