Retinol is one of the most evidence-backed ingredients in skincare for anti-aging, acne, and skin texture improvement. Pregnancy is also a time when many people want to keep their skin in good condition while dealing with hormonal changes. The two don’t combine well, and understanding why helps you make safe decisions during pregnancy without feeling like you have to abandon effective skincare entirely.
What retinoids are and why the concern exists
Retinoids are vitamin A derivatives. The category includes prescription tretinoin (all-trans retinoic acid, the most potent topical form), adapalene, tazarotene, as well as over-the-counter retinol (which converts to retinaldehyde then retinoic acid in the skin), retinaldehyde, and several weaker derivatives like retinyl palmitate and retinyl acetate.
Vitamin A is teratogenic, meaning it causes birth defects, at high doses. This is well established from isotretinoin, the oral retinoid medication prescribed for severe acne. Oral isotretinoin is one of the most strictly regulated medications in many countries because of its severe teratogenic effects: it causes major birth defects at rates that make pregnancy during treatment essentially prohibited. Patients in the US are enrolled in a mandatory Risk Evaluation and Mitigation Strategy (iPLEDGE program) requiring multiple forms of birth control and regular pregnancy testing.
The concern with topical retinoids is whether enough vitamin A is absorbed through the skin to reach the developing fetus at concentrations high enough to cause harm.
What the evidence shows for topical retinoids
The honest answer is that the direct evidence for topical retinoids in pregnancy is limited, because running randomised trials with potentially teratogenic substances in pregnant women is ethically impossible. The evidence comes primarily from observational studies and case reports.
Pharmacokinetic studies (measuring how much of a topically applied substance reaches the bloodstream) suggest that topical retinoids are poorly absorbed. Only about 1-2% of topically applied retinol is estimated to reach systemic circulation, and retinol must convert to retinoic acid through several metabolic steps before it’s the active form. The systemic exposure from topical retinol is far lower than from oral isotretinoin.
Several large observational studies have looked at outcomes in pregnant women who used topical retinoids before knowing they were pregnant or early in pregnancy before stopping. The studies, including a 2020 cohort study in the British Medical Journal with over 56,000 pregnancies, found that first-trimester topical retinoid use was not associated with significantly increased rates of major birth defects compared to non-users. This is reassuring, but the studies have limitations and do not establish safety.
The position of major medical organizations including ACOG (American College of Obstetricians and Gynecologists) and most dermatology bodies is: avoid topical retinoids during pregnancy as a precaution. The potential risk, however small, combined with the fact that retinoids are cosmetic rather than medically necessary for most users, makes the precautionary principle the sensible approach.
What to use instead during pregnancy
The main alternative for the anti-aging benefits of retinol is bakuchiol. This plant-derived compound from the Psoralea corylifolia plant has been studied as a retinol alternative with growing clinical evidence. A 2019 randomised controlled trial published in the British Journal of Dermatology found that 0.5% bakuchiol twice daily was equivalent to 0.5% retinol once daily for reducing fine lines, wrinkles, and skin discolouration, with less facial irritation.
Bakuchiol works through some of the same gene pathways as retinoids but is structurally different and has no known teratogenic effects. It’s generally considered safe during pregnancy, though no formal safety studies in pregnancy specifically exist. Most dermatologists regard it as an acceptable alternative.
Other pregnancy-safe skincare for common concerns during pregnancy:
- For acne (very common in pregnancy due to hormonal changes): azelaic acid is considered safe in pregnancy and has good evidence for mild to moderate acne, glycolic acid, and niacinamide
- For melasma (the mask of pregnancy): vitamin C, niacinamide, and azelaic acid are generally considered safe; hydroquinone should be avoided during pregnancy
- For anti-aging and skin texture: vitamin C serums, peptides, niacinamide, and bakuchiol
- For hydration: hyaluronic acid, glycerin, aloe vera, and plant-based moisturisers are all considered safe
Retinoids to be most careful with
Prescription tretinoin, adapalene, tazarotene, and oral isotretinoin should all be stopped before trying to conceive and avoided throughout pregnancy. These have the highest potency and the most concern from a systemic exposure standpoint.
Over-the-counter retinol, while probably lower risk than prescription retinoids, is still conventionally avoided during pregnancy based on the precautionary principle. If you used it early in pregnancy before knowing you were pregnant, the observational data is reassuring, but the recommendation to stop on confirmation of pregnancy stands.
Very low-potency derivatives like retinyl palmitate are considered lower risk, but products with these are usually not using them at concentrations that would produce significant skin results anyway.
After pregnancy
During breastfeeding, the same caution applies. Small amounts of topically applied substances can reach breast milk, and while the systemic absorption of topical retinoids is low, medical guidance generally recommends continuing to avoid retinoids while breastfeeding.
Once you stop breastfeeding, retinoids can be reintroduced. Post-pregnancy skin changes including melasma, texture changes, and acne often resolve over months, and a well-chosen retinoid product used consistently after breastfeeding ends can help address the skin changes that pregnancy brought.
Bakuchiol can continue to be used throughout this whole period as a gentler alternative. Paired with vitamin C, SPF, and good hydration, it provides meaningful skincare benefits during a time when options are more limited than usual.