Should I reschedule my Botox (botulinum toxin) appointment while trying to conceive (ttc)?

Botulinum Toxin During Pregnancy: Safety Considerations

You should reschedule your Botox appointment while trying to conceive (TTC) due to the lack of adequate safety data and the FDA pregnancy category C classification of botulinum toxin products.

Safety of Botulinum Toxin During Pregnancy

• Botulinum toxin (Botox) is classified as FDA pregnancy category C, meaning animal reproduction studies have shown adverse effects on the fetus, and there are no adequate well-controlled studies in humans, but potential benefits may warrant use despite potential risks 1
• The FDA-approved labeling for botulinum toxin products specifically states: "It is not known if JEUVEAU can harm your unborn baby" and recommends discussing with healthcare providers if pregnant or planning to become pregnant 1
• Women of childbearing potential who are trying to conceive should carefully consider the risks and benefits before using botulinum toxin 1

Limited Clinical Evidence

• Available clinical data on botulinum toxin use during pregnancy is extremely limited and consists primarily of case reports rather than controlled studies 2, 3, 4
• A survey of 396 physicians found only 16 documented cases of pregnant women receiving botulinum toxin injections, with most exposures occurring in the first trimester 4
• While these limited cases did not report adverse outcomes, the small sample size is insufficient to establish safety 4
• Some case reports document apparently successful use during pregnancy for medical conditions like migraines and dystonia, but these represent exceptional circumstances where potential benefits outweighed risks 5, 6

Timing Considerations

• The period of organogenesis (embryonic age 4-8 weeks, corresponding to gestational age 6-10 weeks) carries the highest risk for malformation 7
• When trying to conceive, there is no way to predict when conception might occur, creating a risk of inadvertent exposure during early pregnancy 7
• The risk of teratogenicity and structural abnormalities remains until 20-22 weeks as development continues in some organs 7

Recommendations for Women Trying to Conceive

• For cosmetic procedures like Botox, the safest approach is to postpone treatment while actively trying to conceive 1
• If botulinum toxin exposure occurs during early pregnancy, it is not considered medical grounds for pregnancy termination, but the pregnancy should be closely monitored 7
• Women who become pregnant after botulinum toxin exposure should receive early obstetric review and fetal monitoring 7

Alternative Timing

• Consider scheduling cosmetic botulinum toxin treatments during periods when you are using reliable contraception and not actively trying to conceive 7
• If you decide to postpone your Botox appointment, you can reschedule after either:
  • Successful conception and delivery (botulinum toxin is considered compatible with breastfeeding) 7
  • A period when you are not actively trying to conceive and using reliable contraception 7

While some case reports suggest no adverse outcomes from inadvertent botulinum toxin exposure during pregnancy, the prudent approach for cosmetic purposes is to avoid potential exposure when trying to conceive due to limited safety data and the non-essential nature of the treatment.