Skincare during pregnancy and breastfeeding

20 ingredients that you must avoid to protect your baby from harm.

Do you experiment with new skincare products? Do you include fresh ingredients in your daily regimen, or perhaps, try altering the doses of the existing lot to gain better results? For most of you, it would be a definite yes! There's no reason for you not to practice the trial and error method for OTC products. It is safe to a reasonable extent. Just make sure you have equipped your application with research and a dermatologist's guide.

But all the experiments take a step back when you wish to have a baby or get pregnant. Even when you are breastfeeding, you seem to be apprehensive about what you eat, drink, or put on your skin. As you are aware, there exists a possibility that they may cross the placenta and impact your baby, or maternal milk can come in contact with your baby and prove to be toxic.

When it comes to topical products, the chances of these products interfering with the fetus, or its presence in maternal milk, are significantly less as your body absorbs these in minute amounts. Still, you want to stay on the shore - safe and dry.

Experts mostly advise that one should use the products during pregnancy and breastfeeding, containing their active ingredients in lesser (or not-so-potent) concentrations. However, there are some ingredients that you should straightaway strike out from your skincare routine. 

Let us take a quick look at what the FDA has to say.

The US Food and Drug Administration (FDA) had, earlier in 2015, replaced the old system, which categorized the ingredients (used in different medical and cosmetic formulations) into proper groups.

It had the English letters A, B, C, D, and X assigned to the ingredients based on the studies and their results, concluding how safe an ingredient is during the period of pregnancy. The old system applied to oral medication and did not affect OTC products.

However, many experts still follow this system. And with its help, they examine the ingredients involved in topical products.

If an ingredient is placed under the 'C' category, one can tell that the element may have adverse effects on the fetus. But it can be prescribed by your dermatologist if its potential benefits outweigh its risks. Animal reproductive studies for this exist. Yet, no substantial research was carried on humans.

For an ingredient assigned 'D,' all that you have read in the category 'C' applies to it as well. Except, in this case, you have positive evidence that the ingredients can harm the fetus, and sufficient human studies verify it.

Moreover, for the elements in category 'X,' several studies have been carried out in both humans and animals, proving that they result in abnormalities in the fetus. Due to the severity of the damage they can cause, it is highly recommended to avoid them. 

Note:

Two important terms that you should know the meaning of,
Teratogen: A substance that can cause physical or functional defects in the growing embryo or fetus no sooner than the mother is exposed to it.
Embryotoxicity: Teratogens can be toxic to the embryo, ranging from mild to hazardous. It can impair the developing organs. Or impose a severe defect in both parts (related to the structure or any functional property). In the worst of scenarios, it can even lead to the termination of pregnancy.

Ingredients that you should altogether avoid:

1) Topical Retinoids 

They are vitamin A derivatives, mainly used to treat acne and sun-damaged skin. Different retinoids of varied strengths are available in the market. Here is a table that will tell you about the OTC topical retinoids and the specific categories they are assigned to by the FDA. 

2) Tetracyclines 

What are these? In a word: antibiotics. And yes, they are used in controlling bacterial infections. For many dermatologists, they emerge as the first choice for treating acne.

They are classified under the pregnancy category 'D' by the FDA. Animal studies state that they can lead to critical embryotoxicity in the growing embryo/ fetus.

A few reports claim that their application (mainly oral intake) can cause tetracyclines to deposit in the fetus's teeth actively. Since the deposition is permanent, it exposes the fetus' deciduous teeth to the ingredient, turning them yellow and dark over time. They even get deposited in the bones, resulting in decreased fetal size, inhibiting the fibula growth. 

Note:

These should never be taken in the first trimester (as the baby's organs are still developing). Some experts do suggest these retinoids are comparatively safer to use during the 3rd and 4th trimester. But they also warn that the duration of therapy should be about (4 - 6) weeks. 

3) Soy-based products 

Usually, many women prefer using soy-based products (as lotions or facial products), all thanks to them being natural and vegan.

However, the estrogenic components of soy can bring about any concerns regarding your skin. They mimic the body's estrogen production (the levels of which, during pregnancy, are already exploding).

Women with a dark complexion or who suffer from melasma run a greater risk from soy because it worsens the melasma symptoms or darkens the unwanted patches (forming on the face and body).

Some experts ask to look for active soy, which has its active estrogenic components removed. 

4) Sodium Lauryl Sulfate (SLS) 

You will mainly find the body wash, shampoo (10% - 25%), skin cleanser (less than 1%), etc.

According to the Journal of the American College of Toxicology (Volume 2, 1983), SLS had a degenerative effect on the cell membranes, as it disrupts their protein structure. It can irritate the open patches present on the skin. Experts claim that it is safer to use SLS for shorter periods.

Research shows that long term use can irritate the eyes, nose, and lungs. The concentration should not exceed the 1% limit. It is better to withhold its use during the phases when you are expecting or nursing your baby.

It has been argued earlier that SLS, during its manufacturing process, gets contaminated with 1,4-dioxane. And this particular substance, in animal studies, has shown cancer-causing traits. 

5) Diazolidinyl urea 

Search for it on the labels of shampoos, conditioners, baby wipes, and bath bubbles; you should find it there.

They act as preservatives in these products. Now, the real harm comes when they release small amounts of formaldehyde over time.

Since even the little amounts of formaldehyde can pose significant health concerns, their slow release of it gathers over a particular period, serving as one potential risk.

According to a 2015 study, long intervals of storage and higher temperature increase the amount of formaldehyde released by the concerned preservatives' products. Severe health problems may follow suit (beginning with irritation in the eyes, nose, and even respiratory tract).

A 2009 research conducted on formaldehyde's occupational exposure established the link between leukemia and the very ingredient. 

6) Phthalates

Many experts consider them as "harmful chemicals" and disapprove of all the products wherein they form a composition. Mostly used in sprays, perfumes, deodorants, lotions, and moisturizers, phthalates are potentially toxic substances.

In 2002, three American consumer associations objected against the practice of companies who intentionally hid the entire ingredient list and didn't mention that they used phthalates in their products.

The studies are concerned that it directly affects the male reproductive system's development in the embryo/fetus when one ingests phthalates during pregnancy. A study carried on rodents reflected the endocrine-disrupting effects of phthalates and how it can induce reproductive toxicity. 

7) Products containing fragrances 

The most common additive to several personal care products, ranging from soaps, lotions, and gels to shampoos and conditioners. Of course, you meet them more genuinely in your perfumes and deodorants.

"The products, containing fragrant components, may seem harmless, but they are made up of hazardous chemicals like benzene derivatives, aldehydes, parabens, and more. Reports firmly indicate that these chemicals are linked to cancer and nervous system issues," says Dr. Dendy Engelman, MD, Manhattan, USA. "Moreover, the symptoms for short-term use may include skin irritation and redness in and around the areas of application, runny nose, etc.

She warns people to avoid skincare products with labels suggesting "perfume, linalool, limonene, eugenol, citronellol, geraniol or cinnamal" on them.

Few studies have demonstrated how "artificial and natural spices are added to almost everything that exists in skincare to ensure fragrance to it. They are chemical compounds, and some can turn out to be allergens and carcinogens. 

8) Stearic acid 

According to the US Cosmetic Database, stearic acid is classified as a "low to moderate hazard ingredient."

The studies conducted so far sharply point out that: 

• The acid may lead to toxins in the brain and adversely affect the nervous system. 
  
• A similar build-up of toxins may take place in the other organs. 
  
• It can affect the respiratory system as well. 
  
• It even has the potential to be a carcinogen.
  
• It causes skin irritation (especially if one has sensitive skin or is allergic to the ingredient). 
  
• Even with small doses of the element, side effects have been observed. 
  

It forms a part of the emollients and moisturizers mainly. Dermatologists advise limiting the use of stearic acid during pregnancy. 

9) Hydroquinone 

Hydroquinone is a skin-lightening ingredient that champions the clearing of dark spots and other skin conditions. It has been placed under the category 'C' by the FDA.

In a 2015 study, a model of embryonic stem cell test (EST) was established to find whether or not Hydroquinone was toxic to the growing embryo. The results predicted that Hydroquinone could exhibit strong chemical embryotoxicity.

Deanne Robinson, MD, assistant clinical professor at Yale School of Medicine & co-founder of Modern Dermatology in Westport, Connecticut. Says

Hydroquinone is a controversial synthetic pigment reducer. It is available in the US but under strict regulation. Moreover, it is banned in Europe, Japan, and Australia because of its high potential to act as a carcinogen.
Even the FDA has shown concerns about the same, and has stressed over the need for more studies to evaluate its safety limits better, It definitely should not be used during pregnancy and while one is nursing. 

10) Thioglycolic acid (TGA) 

The FDA gives it a 'C' in the pregnancy category. 

Note:

The absorption of TGA by the skin depends upon the pH of the applied solution. The more acidic the solution, the lesser pH it will have, and the lesser ionized will the molecules get. TGA then can also penetrate the skin better. 

At high concentrations, it can be corrosive. It acts as an ocular skin irritant and should never come in contact with the eyes. Even in the depilatories, the concentration of TGA should never go above 5%.

There are no specific studies that give a proper explanation of the toxicity of TGA and its salts. Yet, it has been reported to impair several organs, especially reproductive organs like the testes and ovaries. 

11) Formaldehyde 

Let's get straight to the severe implications one can face when exposed to formaldehyde during pregnancy. 

• Birth malformations, low birth weight, and spontaneous abortions. 
  
• A significant decrease in fetal growth. 
  

Now, it goes through the debris (absorbed by the skin), or one inhales it or accidentally ingests it. No matter what, it will cause threatening health concerns.

Most of the above data have been collected from animal studies and reports over formaldehyde occupational exposure to pregnant women.

According to the National Institute of Cancer (US), researchers (from data based on studies in humans and lab investigation) have found that exposure to formaldehyde may cause leukemia.

12) Toluene 

It is a clear liquid with an aromatic odor. In the cosmetic and skincare industry, its use is limited to nail products.

This ingredient, too, has significant dangerous effects on pregnant women. Some include: 

• Intrauterine growth retardation 
  
• Premature delivery 
  
• Defects in any organ (related to either the physical, structural, or functional aspects) 
  
• After birth, the growth and development of the baby may show signs of retardation. 
  

13) Bleaching creams 

- Mercury salts 

These are primarily used to prevent melanin formation and are found in skin lightening soaps and lotions.

Any skincare product, which contains mercury, is considered unsafe and damaging to health. Kidney malfunction, skin rashes, discoloration, and scarring of skin are some of the adverse effects. It is also known to cause fetal abnormalities in the case of pregnancy. Hence, doctors always advise you to stay away from mercury products. 

- Ammonia and Hydrogen peroxide 

It would be best if you bid farewell/said goodbye to all the skin bleaching treatments you have had at the salons and even the hair bleaching sessions. By doing so, you may get yourself exposed to the above two ingredients.

Also, the skin gets itchy and sensitive during pregnancy. Don't you think it will be more in your favor to stall all your bleaching appointments until the baby is delivered? A responsible parent would say, yes! 

14) Botulinum Toxin (BtxA) 

The name itself asks you to have your guards all up. Funny enough! But it is one ingredient that you can't let pass easily.

Placed under category 'C' by the FDA, it is used in the anti-aging and scar treatment. It also plays a crucial/vital role in the antiperspirants (to control excess sweating).

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As there are no studies that verify its safety during pregnancy, experts point out that BtxA therapies should be abandoned altogether. 

Note:

Topical aluminum chloride hexahydrate, too, is used as an antiperspirant. FDA assigns it a 'C' in the pregnancy category.

15) Essential oils 

Neither should you ingest an essential oil during pregnancy nor topically apply it in undiluted forms. Some oils can provide you relief through aromatic aid, or if you choose to mix these with carrier oils and then use them on your skin.

Whereas there are some oils that you should avoid during pregnancy. These include rosemary, clary sage, juniper, thyme, and jasmine.  

Why do dermatologists think of these as menacing? 

• They stimulate the uterus and intensify the contractions. 
  
• They sanction the "easy advancement of labor," inducing it further. 
  
• They may result in miscarriages. 
  

16) Diethanolamine (DEA) 

It is primarily employed in making moisturizers and sunscreens. It falls under the pregnancy category 'C.,'

Functioning as pH adjusters in many skincare formulations to balance the other ingredients' acidity. It is also used to add froth and foam to some of the products.

Access to a study published in the FASEB scientific journal (2006), diethanolamine interfered with normal brain development in the baby mice when applied to pregnant mice's skin. 

Minimalist tip:

Parabens acting as preservatives in skincare and cosmetic products, can have severe implications for the baby's weight development (after the birth).

Avoid the ones who have methylparaben, butylparaben, or propylparaben written over them. 

17) Chemical sunscreens 

Oxybenzone, an ingredient dominantly found in the chemical sunscreens, can cause skin irritation. It may call upon hormone disruptions, and at its worst, it can increase the chances of contracting skin cancer.

Some research shows that oxybenzone is absorbed through the skin more than what was once thought. It has been found in large quantities in human blood and breast milk.

According to the Reproductive Toxicology study (2019), a pregnant woman applied a sunscreen (containing 6% oxybenzone) twice a day. It was observed that the ingredient could be absorbed into the bloodstream and may even reach the fetus. Once it does, it may initiate harmful changes in the cells during embryonic development. Because it affects the functioning of hormones (including estrogen), it can produce adverse effects on the fetus's reproductive and immune system; in a few cases, it can even affect the brain. 

Ingredients that you can still use 

Certain ingredients exist, which are considered unsafe for pregnant women, and nursing mothers can still be used if taken with necessary precautions. Two ingredients being: 

1) Pycnogenol 

A multi-functioning ingredient, extracted from the French Pinus Pinaster barks, is an all-in-one remedy. It is an effective antioxidant, has anti-inflammatory properties, and is known to decrease skin cancer.

Early research suggests that it should not be taken during the first three months of pregnancy, as no published data is vouching for its safety in the first trimester. A bunch of studies states that it has no teratogenic effects. Its topical use is under no danger radar. Yet, please talk with your doctor before getting started on it. 

2) Peppermint oil 

Dr. Nada Milosavljevic, founder and director of the Integrative Health Program at Massachusetts General Hospital. Says

It is a controversial one. Even the aromatherapy experts and homeopathic practitioners advise us not to use them during the pregnancy months, Moreover, there is some preliminary evidence that it can reduce nausea in pregnant women.

3) Antibiotics 

Erythromycin and clindamycin are used to treat acne's inflammatory forms (including papules, pustules, nodes, and cysts). They fight the bacterial growth that infests the pores and often play an accomplice to the worsening of acne. They both have been placed under the category 'B' by the FDA.

Erythromycin, in the form of gels, solutions, and ointments, at a concentration of not more than 2%, is considered safe for pregnant women.

Experts approve clindamycin, coming in gels, lotions, topical solutions, and foams, at a maximum of 1%. But yes, you need to abide by a dermatologist's prescribed dosage strictly.