Skincare in Pregnancy
Fertility and pregnancy journeys often begin long before an actual pregnancy, and may continue on afterwards if breastfeeding. During this precious time it is so important not to neglect yourself and if skincare is important to you, then it should remain an enjoyable priority or self-care practice for you throughout.
In order to help you navigate this time we are dedicating this article to highlighting what is safe to use, not safe to use and some helpful alternatives. Just as every person is different, every pregnancy is different, as is every fertility journey along the way. Therefore, our tailored approach is still applied to all of our patients at this time. Here you’ll find some general rules of thumb but it is always advisable to speak with your own physician.
Pregnant women are usually excluded from clinical trials, hence the need to extrapolate safety evidence from numerous case studies or observational studies. In pregnancy changes to hormonal levels, immunity, cardiovascular system and metabolism mean that certain products/treatments that were your heroes pre-pregnancy may not suit you during this time.
Building your pregnancy skincare plan
Here we will provide you with some pointers to help you build a plan based on these concepts. The main ingredients to avoid are;
· Retinoids; look for words like “anti-ageing” as it can be sneakily in there.
· Hydroquinone and arbutin ; look for words like brightening/bleaching.
The main treatments to avoid include;
· Injectables such as wrinkle relaxers, skinboosters and dermal fillers. Once not breastfeeding all of the above are back on the menu!
· Microneedling
· Lasers/IPL; we recommend waiting a few months once breast feeding has ceased or post-partum so as to allow hormonal levels to come back to baseline.
· Energy based devices unless known to be safe in pregnancy.
Some common skin changes that are observed include new onset sensitivity, pigmentation, acne and stretch marks. There are many other known skin conditions but we will limit our discussion to the above.
New onset irritation or sensitivity or worsening of pre-existing inflammatory disorders.
The immune system undergoes significant adjustments during a pregnancy. Changes are made so to protect the mother and foetus from infection, but additionally to protect the pregnancy itself from immune rejection.
During the majority of a pregnancy (aside from very early and at the initiation of labour), the general pro-inflammatory messengers (or cytokines) in your body are downregulated and anti-inflammatory messengers are upregulated thereby creating a more tolerant environment for the presence of a foetus.(1) However, in the skin this anti-inflammatory response can result in sensitivity even to products you may have had no issue with in the past.
There is also a general rebalance in the adaptive immune system from cell-mediated immunity (Th1) to humoral immunity (Th2). A humoral dominant environment is favoured in pregnancy but can increase skin disease susceptibility. Th1 driven processes such as psoriasis tend to improve, but Th2 driven disease like eczema may deteriorate.(2)
What to do if you experience sensitivity in pregnancy
If you experience new redness, stinging, burning or irritation then we have a few steps for you to consider. Our formula for pregnancy associated sensitivity:
· Check your cleanser is not too stripping and consider a switch to gel based or cream based cleanser. Avoid foam-based cleansers
· Remove fragrance if possible.
· Hyaluronic acid serums can be nourishing and helpful.
· Niacinamide can help to soothe the skin
· Mineral sunscreens may be more suitable
· If rosacea is flaring up, consider azelaic acid.
New onset pigmentation or darkening of pre-existing pigment
Numerous factors contribute to pregnancy related hyperpigmentation. Examples include placental hormones, increased endogenous hormones and immune changes. Oestrogen and progesterone increase during pregnancy, stimulating more melanin often through oestrogen receptors in the skin. Additionally, the placenta itself produces sphingolipids, which stimulate tyrosinase, an important enzyme in the pigment cascade.(3)
Common manifestations include the appearance of linea nigra (in up to 90% of pregnancies) or freckles and moles darkening additionally nipples may darken. In the second and third trimester people may develop melasma (believed to effect 70% of pregnancies).
Our formula for pregnancy associated pigment
o Prevention with SPF Is essential. Year round diligent use of SPF is non-negotiable. We also recommend considering a tinted SPF if you are prone to pigment. Don’t forget to re-apply.
o Vitamin C helps to inhibit tyrosinase (the melanin-making enzyme) and it also supports collagen and elastin production so a win-win!
o Azelaic acid also helps target tyrosinase and can be keratolytic so help to keep your complexion bright.
o Alpha Hydroxy Acids such as mandelic, lactic and glycolic (if sensitivity allows) are excellent brighteners.
o Skin calming ingredients like niacinamide are incredibly helpful.
o Folic acid may help reduce the formation of linea nigra (4)
New onset or worsening of Acne
Increased maternal progesterone in 2nd trimester leads to heightened oil production, then higher levels of androgen in the third trimester do the same. As described above, immunity is also altered leading to exacerbation of acne in some individuals. Unfortunately all stages of pregnancy may be affected, but some actually see an improvement believed to be due to heightened oestrogen levels.
Our formula for pregnancy associated acne
o Enzymatic gel based cleanser
o Treat with azelaic acid as it is keratolytic, reduces sebum, is anti-bacterial and anti-inflammatory.
o BHA such as salicylic, less than 2% is acceptable.
o Clay masques are excellent for weekly use.
o Pre and probiotic skincare is another safe option to help balance the biome.
o SPF is essential to minimise inflammation and the risk of post inflammatory marks.
Striae Gravidarum AKA Stretch Marks
It is believed that up to 90% of pregnancies will experience stretch marks making this an almost universal experience. The normalisation of stretch marks is so important. While very little has proven to be effective prevention, we have some advice on how to treat stretch marks if this is your wish.
Our formula for pregnancy associated stretch marks;
· Very little has proven efficacy in pregnancy so we advise keeping the skin hydrated with emollients and protected from the sun.
· Post-partum we have numerous options:
o Strong Retinoids
o Radiofrequency Microneedling
o SkinPen Microneedling
o Lasers/IPL
What to do with your current skincare products
If your skin starts to behave differently, it is probably time to review your skincare. Remember that just because we have to put something to the side for now does not mean it needs to be thrown out. Check the back of your bottles to see how many months the product remains in date once opened. Pop a label on it to remind yourself when you should use it by and place it in a dry, cool, dark storage space. Alternatively, find a friend that deserves a treat and donate your much loved products to them –we are trying to build a circular economy in this world and I can’t keep count of how many sunscreens I have graciously accepted that didn’t suit others and vice versa.
Pregnancy safe in-clinic treatments
In clinic, we remain here for you and your loyal partner on your skincare journey. We love treating our expectant moms to a soothing LED treatment with our special pregnancy pillow. We are excited to expand our pregnancy-safe facial range and are delighted to introduce our community to the innovative skincare name Meder. Meder was formulated by a Swiss based dermatologist, Dr Tina Meder, and it was developed with inclusivity in mind. Based on probiotics, peptides and antioxidants her entire range is safe in pregnancy and breastfeeding. One of the most well-known facials – the Myo-Fix thanks to it’s potent peptides has results that mimic our favourite wrinkle relaxer treatments but are pregnancy safe. As a mother of two, Nurse Caroline is passionate about caring for skin during this special and demanding time, so when you do have a moment to yourself why not pop into Caroline for a restorative and clinically effective treat.
References:
Santner-Nanan, B.; Peek, M.J.; Khanam, R.; Richarts, L.; Zhu, E.; Fazekas de St Groth, B.; Nanan, R. Systemic increase in the ratio between Foxp3+ and IL-17-producing CD4+ T cells in healthy pregnancy but not in preeclampsia. J. Immunol. 2009
Zenclussen, A.C.; Gerlof, K.; Zenclussen, M.L.; Sollwedel, A.; Bertoja, A.Z.; Ritter, T.; Kotsch, K.; Leber, J.; Volk, H.D. Abnormal T-cell reactivity against paternal antigens in spontaneous abortion: Adoptive transfer of pregnancy-induced CD4+CD25+ T regulatory cells prevents fetal rejection in a murine abortion model. Am. J. Pathol. 2005, 166, 811–822.
Kar S, Krishnan A, Shivkumar PV. Pregnancy and skin. J Obstet Gynaecol India 2012; 62: 268–75.
Vora RV, Gupta R, Mehta MJ, Chaudhari AH, Pilani AP, Patel N. Pregnancy and skin. J Family Med Prim Care 2014; 3: 318–24.