Is retinol safe to use in pregnancy? I tell my patients to avoid all retinoids during pregnancy. Retinoids, derivatives of vitamin A, are widely used in dermatology for their efficacy in treating conditions like acne, psoriasis, melasma, and signs of aging. However, their use during pregnancy poses some concerns due to potential teratogenic effects. Oral retinoids like Accutane are known to cause birth defects if taken when pregnant, So what is the risk of topical retinoids like retinol when pregnant? Should you panic if you are using retinol and find out you are pregnant?

In this article, I share what I tell my patients about the safety of topical and oral retinoids during pregnancy. This blog provides guidance on what to do if you find out you are pregnant while using these medications, and discusses the intake of vitamin A during pregnancy, including dietary sources.

Please discuss any retinoid exposures during pregnancy with your doctor.

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Retinoids are a family of Vitamin A derivatives. The safety of Vitamin A and other retinoids during pregnancy depends upon what type of retinoid it is. Oral prescription retinoids are the most harmful to the fetus. Of the topical retinoids, tazarotene is one of the most risky to use. 

Which you use, how much you use, how often you use, and how large the body surface area is when you apply it topically all contribute to how dangerous these retinoids are. You see- the issue is how much of the retinoid gets into your blood stream and passes to the baby. I recommend to all of my patients to avid retinol and prescription retinoids and high doses of Vitamin A supplement swhen pregnant. But sometimes people get pregnant on retinoids and do not realize they are pregnant.  So how dangerous are they? This article will attempt to help you understand your risk but please discuss with your OB/GYN doctor if you are exposed to retinoids when pregnant.

Retinoids come in various forms, including:

1. Oral Retinoids : These are the most risky. Isotretinoin (Accutane), acitretin (Soriatane), and bexarotene (Targretin) are the most well-known oral retinoids used for severe skin conditions. These oral forms are considered the most risky during pregnancy due to their high systemic absorption and potent teratogenic effects.
2. Topical Prescription Retinoids : These are not as risky as oral but can be absorbed so are still considered risky. These include tretinoin, adapalene, and tazarotene, commonly prescribed for acne and skin aging.
3. Retinol : The risk depends on the strength. Low strength retinol is less risky than high strength retinol. Where it is used is also a factor. Using it in a body cream over a large surface area is riskier than using it on the face only. Available in over-the-counter products, retinol is a milder form of vitamin A.
4. Vitamin A and Beta-carotene: Comes in supplements and is also in many foods. These are not risky when in foods. They can be risky in supplements.

Medications are classified into different pregnancy risk categories to help healthcare providers and patients understand the potential risks associated with their use during pregnancy. The U.S. Food and Drug Administration (FDA) categorizes drugs into five categories:

• Category A : Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, and the possibility of fetal harm appears remote.
• Category B : Animal studies do not indicate a risk to the fetus, and there are no adequate and well-controlled studies in pregnant women.
• Category C : Animal studies have shown an adverse effect on the fetus, but there are no adequate and well-controlled studies in humans. However, potential benefits may warrant the use of the drug in pregnant women despite potential risks.
• Category D : There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant the use of the drug in pregnant women despite potential risks.
• Category X : Studies in animals or humans have demonstrated fetal abnormalities, and the risk of using the drug in pregnant women clearly outweighs any potential benefits. These drugs are contraindicated in pregnancy.

These are the pregnancy risk categories associated with retinoids. Retinol is not a drug so it does not have an associated risk category but it turns into all-trans retinoic acid once absorbed in the skin so the risk of retinol in pregnancy is similar to that of tretinoin.

Oral retinoids are highly teratogenic and associated with a significant risk of severe birth defects, including brain, heart, face, and ear abnormalities. Oral retinoids like isotretinoin require strict pregnancy prevention programs to prevent fetal exposure. List of oral retinoids:

1. Isotretinoin (Accutane) : Category X - This drug is known to cause severe birth defects and is strictly contraindicated in pregnancy.
2. Acitretin (Soriatane) : Category X - Associated with a high risk of severe birth defects and contraindicated in pregnancy.
3. Bexarotene (Targretin) : Category X - Known to cause fetal abnormalities and is contraindicated during pregnancy.

Topical Retinoids have lower systemic absorption but still pose potential risks and should be avoided, especially during the first trimester when organogenesis occurs.

1. Tretinoin (Retin-A, Renova) : Category C - Animal studies have shown adverse effects, but there are no well-controlled studies in pregnant women. Potential benefits may warrant use despite risks.
2. Adapalene (Differin) : Category C - Similar to tretinoin, animal studies suggest potential risks, but human data is lacking.
3. Tazarotene (Tazorac, Avage) : Category X - Known to cause fetal harm and is contraindicated in pregnancy.
4. Trifarotene- Category C . Animal studies suggest potential risks, but human data is lacking

Vitamin A is crucial for fetal development, but excessive intake can cause birth defects. High doses of vitamin A, particularly over 10,000 IU per day, are associated with birth defects. Pregnant women should avoid  taking Vitamin A supplements unless prescribed by their doctor.

Vitamin A primarily occurs in two forms: preformed vitamin A (found in animal products like liver, dairy, and fish) and provitamin A carotenoids (found in fruits and vegetables like carrots and sweet potatoes). The body regulates the conversion of provitamin A carotenoids into retinol, making toxicity from fruits and vegetables rare. However, pregnant women should avoid eating large amounts of liver to prevent vitamin A toxicity,

The clearance time is how long it takes for half of a substance to disappear in your blood stream. The clearance time of retinoids differ which affects how long you should wait after using a retinoid before its safely cleared from your body. Please discuss this with your doctor to make sure this data is still accurate because it is such an important topic.

Topical Retinoids : These have a low systemic absorption rate but can still enter the bloodstream. The clearance time of these retinoids varies:

• Tretinoin : It takes approximately 4-10 hours to be mostly cleared from the body.
• Adapalene : It takes about 3.5 to 10 days to be mostly cleared from the body.
• Tazarotene : Metabolized to tazarotenic acid, it takes approximately 1 to 3 days to be mostly cleared from the body.

Retinol : Over-the-counter retinol has a lower absorption rate. However, due to its conversion to retinoic acid, it still poses potential risks, especially if used in high amounts. The exact clearance time varies but it is generally shorter compared to prescription retinoids.

Oral Retinoids : These have higher systemic absorption and longer clearance times, making them more risky during pregnancy.

• Isotretinoin (Accutane) : It takes approximately 2 to 4 days to be mostly cleared from the body, but its metabolites can remain in the body for longer periods.
• Acitretin (Soriatane) : It takes about 10 days to be mostly cleared from the body, but due to its conversion to etretinate, which has a much longer clearance time, it can remain in the body for up to 3 years.
• Bexarotene (Targretin) : It takes approximately 1 to 1.5 days to be mostly cleared from the body, but this can vary based on individual metabolism.

There have been limited reports of birth defects in humans using topical retinoids during pregnancy. Most of the data on teratogenic effects come from studies on oral retinoids like isotretinoin. The lack of extensive human studies on topical retinoids' safety profiles means that the potential for harm cannot be ruled out, warranting a cautious approach.

• Topical Retinol- If you were only using retinol on your face, it is very unlikely that you will have any issues, especially if you were using a low strength retinol only on your face. Discuss with your doctor for reassurance.
• Topical Prescription Retinoids : If you discover you are pregnant while using topical retinoids, don't panic. You are probably fine. Tazarotene is the only topical retinoid with a Category X classification, so while the others are category C with some risk, tazarotene is riskier. There are different strengths of prescription retinoids so risk during pregnancy depends on how strong, how often, and how much body surface area you used the retinoid on. Stop using them immediately. Inform your healthcare provider to discuss safer alternatives and any necessary follow-up.
• Oral Retinoids : If you are taking oral retinoids like isotretinoin, stop the medication immediately and contact your doctor. Due to the high risk of severe birth defects, prompt medical advice is crucial to manage the situation and ensure the health of your pregnancy.

Sunscreen and Vitamin C are both good products to use when you are pregnant. It is best to choose products based on which of the 16 skin types you are. Take the quiz and answer yes to the pregnancy question to get pregnancy-safe skin care products. Here is our collection of pregnancy safe sunscreens:

Besides sunscreen, you need pregnancy safe serums to use instead of retinoids to treat your skin concerns. Here are safer alternatives to retinoids and retinol to use when you are pregnant. Acne, melasma and fine lines and wrinkles are common skin issues that need to be addressed in pregnancy.

• Azelaic Acid : Reduces inflammation and kills bacteria on the skin.
• Benzoyl Peroxide (up to 5%) : Kills acne-causing bacteria and helps to clear pores.
• Glycolic Acid : Exfoliates the skin to remove dead skin cells and unclog pores.
• Topical Antibiotics (e.g., Clindamycin, Erythromycin) : Reduce bacteria and inflammation on the skin.
• Blue light- Blue light can kill acne causing bacteria but can worsen melasma which in common in pregnancy.

• Azelaic Acid : Inhibits tyrosinase to reduce melanin production and lighten dark spots. Is an exfoliant.
• Vitamin C : Antioxidant that helps to reduce pigmentation by blocking tyrosinase.
• Niacinamide : PAR-2 blocker that reduces the transfer of melanin to skin cells. Anti-inflammatory to prevent pigmentation caused by inflammation.

During pregnancy, the best anti-aging skincare product is a physical sunscreen. (Avoid chemical sunscreens whose safety during pregnancy is not well established.) Pregnancy naturally enhances the skin's appearance due to several physiological changes. Levels of growth factors and rejuvenating cytokines increase, and certain genes associated with skin health are activated. Additionally, hormone levels such as estrogen are higher, which boosts collagen production. This increased collagen production requires ascorbic acid (Vitamin C), making vitamin C an essential part of your skincare routine when pregnant so you can enhance this pregnancy skin perk.

Combining vitamin C and a physical sunscreen provides more than adequate anti-aging skincare during pregnancy. Peptides are also a safe and effective option to enhance skin elasticity and reduce wrinkles without posing risks to the developing baby.

Antiaging skin care options that are safe during pregnancy:

• Heparan Sulfate Analog: Is a glycosaminoglycan that helps to enhance skin hydration and repair without posing risks to the developing fetus.
• Hyaluronic Acid : Hydrates the skin by attracting and retaining moisture.
• Peptides : Stimulate collagen production to improve skin elasticity and reduce the appearance of wrinkles.
• Vitamin C : Boosts collagen synthesis and provides antioxidant protection.
• Niacinamide : Improves skin elasticity, enhances barrier function, and evens out skin tone.

During pregnancy, it's crucial to adopt a skincare routine that prioritizes safety while effectively addressing all of your skin's needs. A superior sun protection regimen is essential, so opt for safe physical sunscreens containing zinc oxide or titanium dioxide, as they are free of chemical sunscreens that may pose risks. We recommend avoiding hydroquinone and retinoids due to their potential teratogenic effects. To tailor your skincare routine, take our skincare quiz and ensure you answer yes to the pregnancy question if you are pregnant or planning to conceive in the next few months. This will help you find safe and effective products suitable for your unique skin needs during this special time.

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