From the Guidelines
Topical retinoids are generally not considered safe during pregnancy and should be avoided while pregnant or trying to conceive. The most recent and highest quality study, published in 2019 in the British Journal of Dermatology 1, states that the use of topical retinoids is contraindicated during pregnancy, despite a meta-analysis showing reassuring results. This is due to the theoretical risk of harm to the developing fetus, as retinoids affect cell growth and differentiation.
Key Points to Consider
- Topical retinoids, such as tretinoin, adapalene, and tazarotene, have limited systemic absorption, but the risk of harm to the fetus cannot be entirely ruled out.
- Alternative pregnancy-safe skincare ingredients for treating acne include azelaic acid, benzoyl peroxide, and certain antibiotics like clindamycin, which can be prescribed by a doctor.
- It is essential to inform your dermatologist about pregnancy or plans to conceive so they can recommend appropriate skincare alternatives that pose minimal risk to your baby.
- If you are currently using topical retinoids and discover you are pregnant, discontinue use immediately and consult your healthcare provider.
Important Considerations for Healthcare Providers
- When prescribing skincare treatments for pregnant women, it is crucial to prioritize the safety of the fetus and recommend alternatives to topical retinoids.
- Azelaic acid, which is category B in pregnancy, can be a suitable alternative for treating acne in pregnant women, especially those with sensitive skin or Fitzpatrick skin types IV or greater 1.
- Clindamycin, also category B in pregnancy, can be used in combination with other agents for the treatment of acne, but its use should be monitored closely to minimize the risk of adverse effects.
From the FDA Drug Label
If you are pregnant, think you are pregnant or are nursing an infant: No studies have been conducted in humans to establish the safety of tretinoin in pregnant women. If you are pregnant, think you are pregnant, or are nursing a baby, consult your physician before using this medication.
Based on data from animal reproduction studies, retinoid pharmacology, and the potential for systemic absorption, tazarotene cream may cause fetal harm when administered to a pregnant female and is contraindicated during pregnancy.
The use of topical retinoids in pregnancy is not recommended due to the potential risk of fetal harm. Tazarotene is contraindicated during pregnancy, and there are no studies to establish the safety of tretinoin in pregnant women. It is advised to consult a physician before using these medications if pregnant or nursing 2, 3.
From the Research
Topical Retinoids in Pregnancy
- The use of topical retinoids during pregnancy is a topic of concern due to potential teratogenic effects 4, 5, 6, 7, 8.
- Studies have shown that the teratogenic potential of third-generation retinoids and those reformulated for topical use is generally less than seen with oral administration of earlier generations of retinoids 4.
- Epidemiologic data available are limited, but they suggest little-to-no teratogenic potential associated with real-life use of these compounds in humans 4, 5.
- However, it is still recommended that the use of topical retinoids during pregnancy be avoided due to the potential risks 4, 5, 6, 7, 8.
- In cases of inadvertent exposure, the available data provide some reassurance that adverse pregnancy outcomes are unlikely 4, 5.
Key Findings
- A multicenter prospective study found no significant differences in the rates of spontaneous abortion, minor birth defects, and major birth defects between women exposed to topical retinoids and controls 5.
- Another study reported new cases of birth defects in children exposed in utero to topical tretinoin, but the epidemiological data are still scant and unconvincing 6.
- Animal data support avoidance of many topical agents, particularly known teratogens such as retinoids and salicylic acid, in pregnant women 7.
- The Food and Drug Administration established drug categories to help in the treatment process, and all retinoids should be avoided during pregnancy due to the risk of fetal malformations 8.