Optimizing your skin care during pregnancy
Navigating a pregnancy is a tough journey. Face it, from the moment you announce you’ve got a bun in the oven, advice from friends, family, even perfect strangers, is unending, and often unsolicited. Couple that overload with what we read on the internet and social media, and, well, it’s just overwhelming.
Since our skin is our largest immune organ, and an ever-changing tapestry as a result of the hormonal and physical changes once pregnant, it’s important to treat it gently, and safely on a daily basis, including the time we breast feed and are recovering from childbirth.
As a physician, but also a mom/entrepreneur who innovated in the skin care arena for 9 years, it’s especially important to follow the science when it comes to ingredients and products. Anecdote and story-telling should carry no weight when it comes to your health and safety, or the well-being of your baby.
So here is a brief summary of what you absolutely SHOULD avoid during pregnancy and breast feeding, and what you might ELECT to avoid, based on the fact that we don’t have enough science to endorse use without some reservation.
Essential oils, fragrances, and homeopathic treatments during pregnancy must be chosen very carefully. Some essential oils, especially in higher concentrations, are “emmenagogues” – compounds that can promote the uterus to empty its contents, causing premature labor or miscarriage. Pennyroyal, parsley seed, wormwood, rue, oak moss and lavandula are common emmenagogues. Some essential oils can be dermal irritants – causing “pregnant” skin to react in a negative way. Included in this category are essential oils of cinnamon, marjoram, myrrh, peppermint, rose, jasmine, cedarwood, chamomile, clary sage, ginger and juniper. Eating these in herb and spice form aren’t problematic, but the highly concentrated oils from each respective plant are potentially irritating when applied directly to skin. So look for those ingredients in your perfumes and lotions, as well.
Check with your OB if you are taking any herbal supplements or homeopathic medications, just to make sure they are not interacting with, cancelling out, or making more potent any medications or supplements prescribed during your pregnancy. Herbs like Saw Palmetto, goldenseal (common in herbal cold remedies), dong quai, ephedra and yohimbe are absolute no-no’s! And if you choose to breast feed, get the OK from your doctor or midwife if you incorporate herbs into your daily routine – some can interfere with successful lactation.
Single process hair coloring (color that sits in the hair and on the scalp for a period of time before washing out) has come under fire due to concerns that potential carcinogens (like Arylamines) may be absorbed during the process and circulate to the baby. Although not proven in studies, most OBs will object to this beauty practice. Best to stick with highlights (that don’t make contact with the scalp), or use powdered products that mask your roots while waiting for your little one to make an appearance!
As for shampoos, SLS (sodium lauryl sulfate), may cause irritation during pregnancy, when even our scalp can be more sensitive. And fragrance in some shampoos may just turn your stomach, especially in the first trimester. So consider these when purchasing shampoo. This may be the time you want to try out some gentle products for your baby, and use them yourself! Consider it a pre-bonding experience.
As for makeup, you may have read that parabens are a no-no. Parabens have been used for over 80 years as very successful preservatives in the food, cosmetics and personal care industry, with a track record of gentleness and effectiveness in miniscule doses.
However, a study that kicked parabens into the controversy pool was conducted in Japan several years ago, supposedly linking parabens found in breast cancer tissue to parabens in the maternal environment. What the study didn’t do was look at normal tissue to see if there was the same phenomenon. This study was kicked to the curb and refuted once follow up studies showed that all humans do accumulate parabens in both malignant and healthy tissue, and also excrete them in the urine.
To date there are no DIRECT studies that implicate parabens cause endocrine disruption or cancer in children – only animal studies. And those studied animals received doses of parabens orders of magnitude greater than any possible human exposure. Unfortunately, the lore propagated by the Japan study lives on, and fear of parabens continues to be perpetuated.
Because the seeds of doubt that have been planted are so deep, many manufacturers have now opted to use other preservatives for cosmetics, many of which have the potential to be more irritating to the skin, and may not protect from anti-bacterial growth over the long haul. So patch test any new cosmetic on a couple of inches of your forearm skin for at least an hour or 2, before using on your face. If any redness, itch or irritation, don’t use it. What you applied before pregnancy may not interact in the same way with your “new” skin, so patch test your familiar products as well.
Avoid any cosmetics containing kohl, a deep pigment present in some liners. It can contain lead, which can be absorbed into the mucous membranes and cross the placenta.
ACNE and BREAKOUTS/MELASMA/STRETCH MARKS/DRY SKIN
You thought you were done with acne, right? Those same hormones that confirm a healthy pregnancy also wreak havoc with our oil glands, the balance of bacteria on our skin and in our pores, our skin pigments and skin elasticity.
Acne and Breakouts – certainly never use any oral Accutane or other retinoid compounds – they have been proven, albeit rarely, to contribute to birth defect risk. Topical retinoids are also discouraged due to their oral counterpart’s bad rap – a risk not worth taking. In addition, your exfoliation routine may include Salicylic Acid or other Beta-Hydroxy acids(BHA). What we know is that these medications taken orally can compromise the integrity of clotting and could lead to fetal loss. If used topically, they should applied only for spot treatments or in rinse off facial washed, and not used extensively (like in chemical peels) when pregnant. A safe and effective alternative is using glycolic acid for exfoliation. Sera with vitamin C or lactic acids are considered non-toxic and effective for some. Azaleic acid is also a viable alternative for tough breakouts, as are some topical antibiotics like clindamycin or erythromycin. Avoid TETRACYCLINE – taken orally it can discolor your baby’s teeth, and even lead to congenital defects and cataracts.
The key here, in managing your skin, is to make sure you get the OK from your derm or OB before using your pre-pregnancy regime, and don’t assume over the counter acne medications are safe- always check with your doctor first.
Melasma, also known as the “mask of pregnancy” is a temporary darkening of pigmented cells of the face from UV exposure. Hydroquinones are a class of chemicals used to whiten areas like this, and are known to be absorbed through the skin. Although their use during pregnancy does not appear to be associated with increased risk of congenital defects, the study that generated this conclusion had a small sample size. With little statistical power, best to avoid hydroxyquinones. Your melasma will clear on its own, and just amp up your facial spf during pregnancy (*See below) and wear a hat on those sunny days.
Stretch Marks – no miracles here. Your rate of your weight gain during pregnancy, coupled with your genetics, determines to what extent you develop striae, or stretch marks. That said, skin that rapidly expands does tend to get irritated, itch and using gentle moisturizers on a regular basis will keep you more comfortable. The stretch mark miracle creams out there don’t work, so don’t waste your time. Invest your time in a little more exercise and conscious awareness of your diet to keep your weight gain modest and healthy.
For Dry Skin – use cleanser instead of soap, that way your skin will retain more of its natural oils. Moisturize immediately after bathing, and try to avoid prolonged contact with hot water – it strips your skin of even more natural moisture. Creams and balms tend to cling to and moisturize more effectively, whereas lotions need to be applied more frequently. Look for the seal of the National Eczema Association on skin products – they tend to have the safest, most effective ingredients, especially for our more reactive skin during pregnancy.
AT YOUR SALON/AESTHETICIAN
The protein in nails is called keratin, and basically is as impenetrable as a rhino horn. So nail polishes and lacquers can be safely applied during pregnancy. What may put you at risk is vigorous cutting and removal of cuticle and callous – putting you at risk for secondary bacterial infections. So have your nail gal gently push your cuticles back, opt for well-buffed nails if you don’t want polish, and sit in the most well-ventilated area of the salon to avoid inhaling fumes. Periodically ask for a foot massage to help stimulate blood flow in your lower legs – that’s the best treat at your salon!
Also, if you suffer from nail fungus, avoid oral anti-fungals during pregnancy. Unfortunately topical agents aren’t hugely effective, and are glacial in their ability to show improvement, so best to stop any anti-fungal intervention when it comes to your nails until after you stop breastfeeding.
As for waxing, especially if involving large areas, or the bikini area, you do run a slight risk of secondary infection or painful ingrown hairs. So assess the cleanliness and hygiene of your salon treatment areas, and march right out if you see the aesthetician double dip into the wax (a new stick should be used each time).
You are beautiful. Avoid injecting your face or body with botox or fillers during pregnancy. We have no data to know whether they are safe to use during pregnancy, so hold off until after your little bun is outta the oven!
WHEN OUT IN THE SUN
So many of my young moms developed skin cancer in their 30’s – having spent many years outside without protection from UVA and UVB rays. I can’t emphasize enough how protecting your skin, whether you are pregnant or not, is the single most effective cancer-prevention intervention you can take. Chemical sunscreens, although effective and inexpensive, are much more irritating to skin, especially when pregnant. Much like parabens, the chemicals commonly used like oxybenzone, have been shown to cause endocrine disruption in animal models in the lab. There are no human studies to date to correlate with animal models. That said, there are very safe and effective alternatives to chemical sunscreens – specifically mineral based products.
You should aim for an spf of 30, and can achieve that with either a solely Zinc based product (for it to have both UVA and UVB protection, it must be present in a high %), or alternately a Zinc Oxide and Titanium dioxide combination which can achieve the same. Look for Broad Spectrum (UVA and UVB) protection, water resistance up to 40-80 minutes, and if your skin is super sensitive, use a product designed for baby, or one that is hypoallergenic.
Love your skin like you will love your baby, and you will both live long and prosper. All the best to you new moms out there!
For a YouTube link to the Home & Family segment on this topic go to: https://youtu.be/AnTPrVOn9AU