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Overview

Think about everything you put on your skin and hair, from when you step in the shower to when you step out your front door. We use a ton of products every single day; shampoo, conditioner, body wash, shaving cream, lotions, face wash, toner, moisturizer, deodorant, sunscreen, makeup, hair products. All of those products you use add up to a very long list of chemicals you introduce to your body. Pregnancy is a period during which you want to be cautious about the chemicals you expose yourself to because some of those chemicals have the potential to cross the placenta and reach your baby. The idea that you could potentially expose your baby to something toxic is scary, and there is a lot of fear around using safe skincare and personal products when you are pregnant. You should avoid a few ingredients and be aware of other controversial ingredients with less clear evidence on the risks. This episode breaks down the evidence on what ingredients have risks that you should be mindful of, how to find safe skin and body care products, and how to understand marketing claims like “non-toxic”.

Article and Resources

Your Skin is an Organ

Your skin is your body’s largest organ. Some skin functions include being a protective barrier, regulating body temperature, and producing vitamin D from the sun. Layers make up your skin, and each layer serves a different function. The top layer is the epidermis which contains melanocytes that give your skin color. The next layer is the dermis, made up mostly of collagen. The dermis also contains sweat glands, oil glands, hair follicles, blood vessels, and nerves. The deepest layer is the hypodermis which is subcutaneous fat.

Your skin also has a microbiome and can absorb ingredients. There are topical patches that deliver medications like birth control. You can topically apply magnesium to your skin to be absorbed. It makes sense that you should be cautious about the chemicals you are putting on your skin. Some of the substances and products you apply topically will be absorbed into your system. During pregnancy, some of those chemicals have the potential to cross the placenta and reach your baby.

Skincare Safety During Pregnancy

Pregnancy is a period during which you want to be cautious about the chemicals you expose yourself to for the safety and health of your baby. The first trimester is the most critical for development. This period is when your baby is building all of their systems, organs, and structures. Some chemicals or substances can negatively impact development, and some can have devastating consequences for your baby.

Once you are past the first trimester, most of your baby’s major systems are in place, organs are developed, and some are even functioning. In the second trimester, their lungs and nervous system are continuing to mature. By the third trimester, your baby is mostly putting on weight and getting bigger and stronger. Your baby is most sensitive to interference with development early on and less vulnerable later in your pregnancy.

Ingredients

If you have looked at the ingredient list on any skincare product, many ingredients are often listed, most of which you cannot pronounce and likely are not familiar with. The FDA in the United States regulates skincare, and we have different standards than other countries, like those in the EU.

The first thing that you should know is that not every ingredient will be on the label. FDA cosmetic labeling regulations state that ingredients considered trade secrets need not be disclosed on the label. Instead, you may see “and other ingredients.” Additives used for fragrance may also be listed simply as “fragrance” without disclosing what those ingredients are.

Fear of Toxic Ingredients

The idea that you could potentially expose your baby to something toxic is scary, and there is a lot of fear around using safe skincare and personal products when you are pregnant. When you start reading articles and blog posts online, it is easy to go down a rabbit hole of panicking about all of the “toxic” ingredients in all of the products you use on your body. The purpose of this article is to break down the evidence on what ingredients have risks that you should be aware of and how to find safe skin and body care products. We will also break down marketing claims and how to understand what terms mean.

Ingredients to Avoid or Be Cautious About

There are a few ingredients you should steer clear of when you are pregnant. Other ingredients are controversial, with less clear evidence on the risks. Let’s examine the safety and potential risks of these ingredients.

Vitamin A Compounds

Vitamin A is a powerful ingredient that can improve your skin, from clearing up acne to improving signs of aging. Unfortunately, some forms of it can be dangerous during pregnancy. There are different types of vitamin A, and they carry different levels of risk.

Isotretonin

Isotretinoin is taken orally and is strongly associated with congenital disabilities. In the U.S., prescription requires two negative pregnancy test results, and the prescribing doctor must document two forms of birth control. Plus, if you are of reproductive age, you have to have monthly pregnancy testing. Under no circumstances should you take Isotretonin during pregnancy.

Topical Retinoids

Other forms of vitamin A compounds are topical retinoids. This includes tretinoin, a retinoic acid that goes by many different brand names, like Retin-A. Tretinoin is only available by prescription in the United States. The American College of Obstetricians and Gynecologists states that the amount of medication absorbed by the body from topical retinoids is low. However, it is generally recommended that you avoid the use of these medications during pregnancy. There should be some warning on labels for any retinoid product to consult a doctor if you are pregnant. Topical retinoids can go by many different names, including retinaldehyde, hydroxypinacolone retinoate, retinol, retinol propionate, retinyl palmitate, and retinyl acetate. The concern over topical retinoids is that they are related to isotretinoin, which is strongly associated with congenital disabilities.

Another issue with vitamin A compounds is that these compounds can increase skin sensitivity. Your skin may already be more sensitive during pregnancy. Please consult with your dermatologist, doctor, or midwife before using any product with vitamin A during pregnancy.

Prescription Acne Medications

The American College of Obstetricians and Gynecologists also advises against other prescription acne medications during pregnancy. This includes hormonal therapy and tetracyclines, which are associated with the risk of congenital disabilities. ACOG states that over-the-counter products containing topical benzoyl peroxide, azelaic acid, topical salicylic acid, and glycolic acid may be used to treat acne during pregnancy.

Hydroquinone

Hydroquinone is a skin-lightening agent. One property that makes this different from other topical treatments is its high absorption rate at 35-45%. In 2020 this was banned as an ingredient in over-the-counter skin products in the U.S. Other countries had banned this years ago. It is available with a prescription, and of course, you would want to disclose to your dermatologist or doctor if you are pregnant or trying to become pregnant.

Fragrance

While fragrance will appear on the ingredient list, the specifics of what this includes are protected by the FDA labeling laws under trade secrets. The International Fragrance Association has a list of ingredients used under the umbrella term “fragrance.” This list is compiled from all fragrance ingredients used in consumer goods by the fragrance industry’s consumers worldwide. As of July 2021, this list includes 3,999 ingredients. Manufacturers are responsible for the safety of the ingredients they use in their products, and concerns have been raised around some of the classes of ingredients used in fragrance.

Fragrance can include ingredients that are allergens, hormone disruptors, and phthalates. If you want to avoid fragrance, look for products labeled as “fragrance-free.” You should be aware that products labeled “unscented” may contain fragrance ingredients. This is because fragrance ingredients also include ingredients used to mask the unpleasant smell of other ingredients, even if they don’t give the product a noticeable scent.

Parabens & Phthalates

Parabens are preservatives that prevent mold and bacteria growth. Phthalates are widely used in everything from personal care products to plastics and are commonly included in fragrances. There is some controversy over the safety of these ingredients.

On one side of the debate, you have the FDA. The FDA states at this time, we do not have information showing that parabens, as they are used in cosmetics, affect human health. Also, according to the FDA, the phthalate commonly used in fragrance products is diethyl phthalate or DEP, which does not pose known risks for human health as it is currently used in cosmetics and fragrances.

On the other side of the debate, the Environmental Working Group leads the charge and cautions that parabens and phthalates cause endocrine disruption and reproductive harm and should be avoided, especially during pregnancy. The EWG links to a lot of research to support their recommendation to remove these ingredients in personal care products.

The gap between these two viewpoints is not black and white. There is evidence showing there are risks associated with these chemicals. The studies typically measure levels of parabens or phthalates in urine, amniotic fluid, or cord blood, compared to the reported use of personal care products from questionnaires. We are exposed to these chemicals from many things in our environment, not just skincare products. Also, cleaning products, items in your home, plastics we use, even foods can contain these chemicals. In today’s environment, it would be challenging to altogether avoid phthalates and parabens 100%.

If you want to be mindful about your exposure through the skincare or personal products you use, you can read the ingredients and labels of products. Parabens are easy to spot in an ingredient list. Although there are many types, they all have the word “paraben” within the name, such as methylparaben. If you want to avoid parabens, you can look for products labeled paraben-free or check the list of ingredients. Phthalates are often included in fragrance and may not be individually listed on the ingredients list. The easiest way to avoid most phthalates is to look for products labeled phthalate-free or fragrance-free.

Essential Oils

Some companies use essential oils as a more natural solution to adding fragrance to products. There are some risks of using topical essential oils, including skin irritation, allergic reaction, photosensitivity, and eye irritation. There is a difference in exposure between utilizing a skincare product with essential oil and an essential oil directly on your skin or mixed with a carrier oil and used topically. For evidence-based information on using essential oils during pregnancy, see this article.

Sunscreen 

Another product under scrutiny for ingredient safety is sunscreen. Rather than use sunscreen, you can wear a hat to keep the sun off your face, or wear clothing to protect your skin, or spend time in the shade. If you are outdoors and have exposed skin, you should be using sunscreen. There are two types of sunscreen; chemical sunscreens absorb the sun’s rays, and physical sunscreens stay on the surface of your skin and deflect rays. Claims on sunscreen labels, like water-resistant, the SPF, or broad-spectrum, are governed by FDA requirements. Sunscreen is subject to more stringent requirements than other skincare products because the FDA regulates it as a drug. This classification is due to the product making a drug claim that it helps prevent sunburn or decreases the risk of skin cancer or early aging caused by the sun.

SPF

SPF stands for sun protection factor. SPF measures how much UV radiation is required to produce a sunburn on protected skin compared to skin without sunscreen. Scientists determine SPF in a laboratory by applying sunscreen to a small patch of skin, exposing it to UV light, and measuring how long it takes for the skin to turn pink. It is a common misconception that an SPF rating tells you how long you can stay in the sun without getting burned. The goal of regulating SPF measurements is to allow you to compare two different sunscreens. An SPF of 30 is stronger than an SPF of 15. Both should be reapplied every two hours or after going in the water or sweating.

Sunscreen SPF only pertains to UVB. You want a broad-spectrum sunscreen for protection against UVA. The American Academy of Dermatology recommends an SPF of a least 30, which blocks 97% of UVB rays. No sunscreen can block 100%. You could get a higher SPF, but 30 should be sufficient. 

Ingredients in Sunscreen

There has been a lot of controversy over the safety of ingredients used in sunscreen. Recently, Johnson and Johnson voluntarily recalled sunscreens made by Neutrogena and Aveeno due to contamination with benzene, a chemical that causes cancer. This happened after an independent third-party tested 294 products and found benzene in 78 of them.

Chemical sunscreen is absorbed better by your skin than physical sunscreen, which tends to stay on the surface of your skin. There is evidence to show the active ingredients, like oxybenzone, in sunscreen are absorbed. In a systematic review of 29 studies, researchers did not find sufficient evidence to support a causal relationship between oxybenzone and adverse health outcomes. With the scrutiny on safe skincare and sunscreens, we will hopefully see more data in the future.

If you have any concerns about chemicals in sunscreens, the Environmental Working Group Skin Deep website offers a free guide for sunscreen. The EWG recommends avoiding products with oxybenzone, vitamin A (retinol palmitate), added insect repellant, and sprays and powders. The simplest way to cut back on some chemicals is to use a fragrance-free lotion. For more information on sun exposure during pregnancy, see this article.

Skin Care Industry

The skincare industry is estimated to reach nearly 190 billion U.S. dollars by 2025. Marketing for these products can make deciphering which products are safe challenging. The demand for natural and organic products is growing faster than the industry as a whole. Celebrities and influencers are constantly bombarding us with skincare recommendations, and there are so many options for products out there. No one solution is right for everyone, and skincare is very individualized. As you find products that work for you, let’s break down how to understand the marketing claims and labels on the skin and personal care products.

Natural, Organic, Non-toxic, and Clean Beauty Products

There has been tremendous growth and demand for skin products without harmful chemicals. It can be confusing trying to figure out what ingredients to avoid. There has been pushback to the move to “clean beauty” by some dermatologists and estheticians. To put it lightly, this is a complicated debate far beyond my scope of knowledge and what can be researched and covered for an episode of the podcast.

Natural

The term “natural” is not an FDA-regulated term. The Federal Trade Commission has issued rulings against companies who promoted their products as “all-natural” or “100% natural” when they contained synthetic ingredients. The FTC requires that if a company labels a product as “natural,” it cannot contain artificial ingredients or chemicals. Since the FTC does not approve products before going to the market, they only enforce this rule if someone files a complaint.

Organic

The FDA does not define or regulate the term “organic” for cosmetics, body care, or personal care products. Labeling a product as organic requires compliance with the USDA rules for organic products. The majority of skincare and personal products labeled organic must contain a minimum of 95% organic ingredients (excluding water). If the label states “Made with Organic (insert ingredient),” then the product must contain at least 70% organically produced ingredients. Few beauty products are made with 100% organic ingredients.

Cruelty-Free or Not Tested on Animals

The terms “Cruelty-Free” or “Not Tested on Animals” have no legal definition. According to the FDA, Many raw materials used in cosmetics were tested on animals years ago when they were first introduced. A cosmetic manufacturer might only use those raw materials and base their “cruelty-free” claims on the fact that the materials or products are not “currently” tested on animals.

There are organizations that have high standards for brands to meet to certify that their products are not tested on animals. You usually see some logo with a bunny on the label, noting the product is cruelty-free or not tested on animals.

Hypoallergenic

The term “hypoallergenic” signifies that a product produces fewer allergic reactions than other products. According to the FDA, there are no federal standards or definitions that govern the use of the term “hypoallergenic.” The term means whatever a particular company wants it to mean.

Non-Toxic and Clean Beauty

Many words like “non-toxic” or “clean beauty” are also not regulated and do not have a legal definition. Just because something is labeled with one of these terms doesn’t mean it is better or safer. These terms are simply marketing. To know whether a product contains ingredients you may want to avoid, you must read the ingredient label.

Pregnancy Warnings on Labels

Cosmetic and skincare products are not required to have FDA approval before they go on the market. There is an exception to this rule for color additives. The legal responsibility for the safety of products is on the companies and individuals who manufacture or market these products. In an abundance of caution, and to avoid litigation, it is common to see a warning or disclaimer on many products about pregnant or breastfeeding women. It usually reads, “Consult with a doctor if pregnant or breastfeeding” or “Do not use if pregnant or breastfeeding.” If you question whether a product is safe, you can always bring it with you to your next prenatal appointment and run it by your doctor or midwife.

You Have Lots of Options

You may have products you love that work, and you are comfortable with the ingredients. Perfect, don’t change a thing. On the other end of the spectrum, you may want to be overly cautious and rehaul the products you use to be as safe as possible during pregnancy. Or you may fall somewhere in the middle, where you want to take some precautions without sacrificing your favorite products. Navigating pregnancy is all about finding solutions that fit you and that will differ from one parent to the next.

Factors to Consider with Potential Risks of Ingredients

We use products to make our skin (or hair) look better, repair damage, or be healthier. The chemicals and active ingredients in these products are what makes them effective. There are many factors to consider when comparing the potential risks of products versus the benefits of using them on your skin.

Toxicity is Dose-Dependent

When you apply something to your skin, only a fraction of it (typically 1-2%) gets absorbed into your system. Whether you leave a product on or rinse it off plays into how much of it you absorb. Some products are designed to be rinsed off, like cleansers. Other formulas, like serums or moisturizers, are intended to be left on to absorb into your skin. The area of your body you are applying products to also matters. If you are putting lotion on your entire body, there is a lot more skin area to absorb product than if you only apply it to your face. In addition, how often you are using products also impacts your exposure. One way to limit your exposure is to use fewer products or cut back on how often you use them. You may also choose to cut back on products during the first trimester.

You May Not Need to Replace Your Current Products

If you like the skincare products you currently use, and they do not contain ingredients specifically cautioned against by ACOG, don’t change a thing. It can be challenging to find products that work well for your skin. If you have a skincare routine that continues to work for you throughout your pregnancy, keep it. If you start reacting differently to your current products due to increased skin sensitivity, it may be time to cut back on products or find different ones. You can always bring a product with you to your next prenatal appointment and ask your doctor or midwife about it if you have any questions or concerns.

Finding Safe Skin Care

If your goal is to use the safest products, the Environmental Working Group has combined databases and studies. They compile many resources and information into rating beauty products for safety. The EWG rates products on a scale of one to ten, with one being the safest and ten being the most harmful. It also breaks down ingredient concerns by cancer, development and reproductive toxicity, allergies, and immunotoxicity, and use restrictions. The EWG is very conservative, and many of the ingredients they caution against are currently deemed safe by the FDA.

The EWG’s Skin Deep database works well if you’re looking up one specific item. It can be overwhelming if you’re looking under a broad category like cleanser, which will list hundreds of products. If you’re looking for a new product, I recommend typing in a brand name that you like and see what the scores are of their different products. You can also scroll through a few pages of the products with lower, safer ingredient list scores and look for brands that you’re familiar with that may pop out at you.

Additional Resources

There are some additional resources you can check out for more information on skincare and product safety.

The Mother to Baby website is a source of information on medications and exposures during pregnancy and breastfeeding. You can see their article on skincare, which also has links to fact sheets on specific ingredients.

The LactMed database is an excellent resource for the safety of medications and ingredients when breastfeeding.

If you want to learn more about how different ingredients impact your skin and the book Skin Care by Caroline Hirons is an excellent resource. Caroline Hirons is an internationally recognized esthetician who is a skincare expert. Her book breaks down what different ingredients do, how to care for your skin, and how to find the right routine and products for you.

Seeing a Dermatologist

If you have skincare issues that you cannot treat on your own, please seek the help of a dermatologist. A Dermatologist is a doctor that specializes in skin, hair, and nails. They go through 12 or more years of school and extensive training to be experts in their field.

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