Retinol while Breastfeeding: Is it Safe?

Contributed by Dr. Andreas, Dr. Sandra Lee, NCBI

Disclaimer

You need to contact your OBGYN and get their professional advice. The data in this article is for informational purpose only and should not be taken as medical advice as it has been gathered from clinical studies and general dermatologist consensus of different Retinoids.

Summary

Using Differin and Retinols is considered safe for pregnant or breastfeeding women, however Tretinoin is “not safe” during pregnancy because of the theoretical risk of causing birth defects. Tretinoin is considered safe to use while breastfeeding.

Using Retinol while breastfeeding or during pregnancy is considered safe because there is extremely low systemic absorption of retinol in our body, however, consultation with your dermatologist and ob gyn is required while using prescription retinoids like Tretinoin and Tazarotene or oral Retinoids.

Keep in mind that there is no actual clinical study to prove what is safe and what isn’t due to the obvious ethical reasons. These are just warnings and theoretical risks. If you are still concerned, it is just best to avoid all forms of Retinoid altogether and be at peace.

The concern of whether a skincare ingredient is safe for a pregnant woman is that will the ingredient affect the fetus development or affect the mother’s health while pregnant? The concern for breastfeeding women and skincare ingredients is that will it affect the production of breastmilk or will the ingredient be systemically absorbed so much that it will reach the breast milk causing potential toxicity to the newborn baby?

It’s important that you discuss with your healthcare provider about the retinol that you are using and how you are using them because depending on the surface area and location of the body that you are applying retinol could impact recommendations.

This is what we know about how certain skincare ingredients are absorbed. In general, we don’t know a whole lot about what is “safe” and “unsafe” during pregnancy or lactation, so we always err on the side of caution.

Retinols are not as regulated as retinoids. Retinols seem to be very low risk and considered okay while breastfeeding.

Differin seems to be okay as there is very low likelihood that it can be absorbed to a significant extent nor is it likely to be excreted in the breastfeeding milk in any appreciable quantity.

When it comes to Retin A (Tretinoin), it is advised to stop the use of tazarotene during pregnancy because of the theoretical risk to the fetus. The amount of absorption is so low into the skin, it is very unlikely that Tretinoin will be present in breastmilk, so as your treatment healthcare provider might advise you, it’s probably okay during breastfeeding however exercising caution depending on the location you are putting it (not applying on the breast).

Tazarotene (Tazarac) has about 6% transcutaneous absorption and theoretically it is much lower risk because it is less lipophilic (does not dissolve in lipids or fats) as compared to other Retinoids. However, caution is advised, it is not recommended that it be applied to more than 20-35% of an individual’s body surface area.

Retinoid Type	During Pregnancy	While Breastfeeding
Retinol	Safe	Safe
Differin (Adapalene)	Safe	Safe
Tretinoin	Not Safe	Safe
Tazarotene (Tazorac)	Caution is advised	Caution is advised

Other Ingredients That Are Safe during Pregnancy and Breastfeeding

Almost All Skincare products are Safe

Our top layer of skin (stratum corneum) is built naturally in a way that it blocks all acids and ingredients from systemically penetrating deeper and reaching our bloodstream. So most of your products are considered safe during pregnancy and while breastfeeding. There are just a couple of skincare ingredients to be concerned about, which are listed after this section.

Alpha Hydroxy Acids (Lactic, Mandelic, Glycolic)

Systemic absorption into the body from AHAs is extremely minimal and they are considered safe during pregnancy and while breastfeeding.

It seems to be okay to use upto 2-3% Salicylic Acid during pregnancy and while breastfeeding since a very low amount is absorbed into the skin. However, a higher percentage of Salicylic Acid which you would get with prescription is generally not advised during breastfeeding.

Azelaic Acid

Safe for use when pregnant or while breastfeeding.

Sunscreen

Sunscreens are safe to use when pregnant and while breastfeeding, particularly zinc, titanium dioxide sunscreens are recommended for melasma, hyperpigmentation. Sunscreens are also essential to use to take care of your skin.

Rogaine (Minoxidil)

A concern that arises after pregnancy is postpartum hair loss and it is safe to use Rogaine (Minoxidil) as only 1.4% of rogaine is absorbed systemically. Topical Rogaine or Minoxidil are safe to use during lactation.

Clindamycin

Systemic use of clindamycin reported no risk of malformations among 647 women during pregnancy.

Benzoyl Peroxide

Safe during pregnancy and while breastfeeding because only 5% of it is absorbed in the skin. The skin metabolizes it to benzoic acid and excretes it via the urine.

Other Ingredients That Are Not Safe during Pregnancy and Breastfeeding

Spironolactone

Used for hormonal acne & hair loss, Spironolactone is contraindicated during pregnancy because you can have negative effects on the developing fetus. However, consensus opinion says it is thought to be safe while breastfeeding. There is a theoretical risk that it would affect milk production as it interferes with some hormonal signalling and receptors.

If you are using a prescription salicylic acid, it may be higher than the over-the-counter 2-3% BHA, which is not advised to be used while breastfeeding because of the theoretical risk of systemic absorption and getting into the breastmilk. Your baby could ingest salicylates which are similar to aspirin so it can lead to aspirin toxicity risk.

Accutane (Isotretinoin)

This is not tretinoin, but an oral version of Vitamin A. It is used to treat acute severe cystic acne. It is directly related to malformation of the fetus.

Hydroquinone

Gold standard for treating hyperpigmentation but banned in several countries, hydroquinone has about 35% transcutaneous absorption. It doesn’t seem though that it would concentrate in breast milk or have any effects on the baby while pregnant. However, it does have a very high absorption rate upto 45% so it is recommended to avoid hydroquinone while pregnant or breastfeeding. As always, talk to your healthcare provider.

Safe Retinols Marketing Gimmicks

When you are at the stage of your life when you are pregnant, or just had a baby and you’re bonding with the baby, you are in that vulnerable period of being misled by a lot of marketing claims that a product is “safer” than another competing brand because it contains “all-natural” or “non-toxic ingredients”. Be a smart consumer when reading such claims because they are not literally feeding babies their product to find if it's toxic or not. Such studies don’t exist so it is quite misleading.

Conclusion

Apart from Tretinoin and Tazarotene, Retinol is considered safe. In general, apart from Hydroquinone and topical prescription retinoids, skincare products are not expected to cause any malformations or any adverse effects for the unborn baby.

Whether a skincare ingredient is safe or not while breastfeeding or when pregnant depends on the type of ingredient, the concentration of that ingredient and where you are applying it on your body. Definitely bathing your body with retinol is not recommended and applying on the breasts is also a big no. What we see is most retinoids are generally safe to use but theoretically they could be absorbed into your skin and may pass into the breastmilk. The best way to approach the use of retinol would be to be at the side of caution and discuss all your prescription and over-the-counter skin care products with your healthcare provider.