Why you should avoid retinoids in pregnancy!

Retinoids are a form of Vitamin A. 

With significant antioxidant properties and wound healing qualities, retinoids have been touted as having magical skin care and anti-aging benefits. People use them for prevention and treatment of wrinkles, blemishes, acne, discolorations … basically any skin care complaint one might have.

And what, you ask, is the difference between a retinoid and a retinol? Retinoids is the general term that is used to describe all sorts of vitamin A related skin care. Retinol is a specific type of retinoid. Retinoic acid is the strong stuff, usually by prescription only. Other types of retinoids are listed below too!

Vitamin A, in general, is necessary for fetal development in pregnant people. 

Image: Angel Sinigersky

It is essential for vision, skin integrity, and bone development for the fetus. Although most people in the US get adequate amounts from their diet, it is also in prenatal vitamins. Expert recommended supplementation dose is less than (or equal to) 5000 IUs daily. 

But … vitamin A can cause harm to a developing fetus when exposed to high levels. That is why retinoids are avoided in pregnancy!

Vitamin A overdose can cause defects from the brain to face to heart to kidneys and can be severe. Perfect example of too much of a good thing being bad!

Let’s get a bit more detailed about the retinoid part of this discussion!

Image: Alexandra Tran

Retinoids can be divided into a few sub-groups. The most common are isotretinoin, tretinoin, acitretin, and adapalene.

  • Isotretinoin is BAD for pregnancy. Isotretinoin in pill form is called Accutane. It is absorbed into your blood stream and crosses the placenta. If you are using Accutane you need to use birth control! There is an actual law that mandates some sort of contraceptive use while actively using an Accutane prescription. Exposure in early pregnancy can cause miscarriage or any of the birth defects I listed above (in up to half of all exposed pregnancies / babies). 
  • Tretinoin, acitretin, and adapalene are all applied to the skin, NOT systemically like isotretinoin.  These topical treatments are all THEORETICALLY BAD for pregnancy. Because they are applied topically, only small amounts pass into the blood stream, and then even smaller amounts cross the placenta to reach the developing baby. Unfortunately there are some reports that using these medications have caused birth defects – the same birth defects that are attributed to Accutane. That’s enough to convince me and other experts recommend avoidance of retinoids in any shape, form, or function during pregnancy.

What to do?

Stop using your beloved Shani Darden Retinol Reform or any other retinoid about 1 month before you try to get pregnant. If you accidentally get pregnant, stop as soon as you find out. Let your doctor know your exposure.  

Treat your skin complaints with something that is safe for pregnancy instead. Your OB or dermatologist should be able to steer you in the right direction – safe alternatives usually include acids like azelaic, glycolic, and salicylic; benzoyl peroxide, Vitamin C, and other serums.

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