A Clear Complexion
Women with acne often experience flare-ups during pregnancy, but you may not be able to rely on your usual treatment. Foremost, you must avoid the drug Accutane, a man-made form of vitamin A, which is an infamous teratogen. This oral drug causes miscarriage or birth defects in the offspring of about half the women who use it, according to Briggs. That's why women must get regular pregnancy tests and use two forms of birth control while they're on it. (The drug is categorized as a class X drug, meaning that it can cause harm when used during pregnancy.) OTIS advises stopping the drug at least a month before you plan to conceive.
If you need to take an oral drug, the antibiotics erythromycin and amoxicillin are safe, but avoid tetracycline, which can cause a child's teeth to become discolored, and trimethoprim-sulfamethoxazole (Bactrim, Septra), which may cause problems when used in the first trimester.
It's also best to avoid topical drugs called tretinoins (Retin-A, Renova, and Retinol), which are related to Accutane. The drugs were once considered safe in pregnancy, but in recent years, several reports of malformations similar to those caused by Accutane have surfaced, Briggs says. Although they are applied to the skin, not ingested, and there is no proof of a connection, many experts now advise their pregnant patients to avoid them. "I'd at least avoid using them during the period when organs are developing -- from five to twelve weeks past the first day of the last menstrual period," Briggs says. "That's the period of greatest vulnerability in pregnancy." Instead, try benzoyl peroxide or azelaic acid to treat acne; these topical treatments are considered safe to use during pregnancy.
As for cosmetic treatments, most doctors advise against using any questionable product that you don't need when you're expecting. That includes the wrinkle eraser Botox, made from botulism bacteria, says Dr. Reed. Botox is a category C drug, which means there are no adequate studies in humans or that animal studies have uncovered adverse effects. But microdermabrasion and chemical peels that use glycolic acid are not considered a problem. Avoid peels involving other, less studied chemicals, and always ask your doctor if you are unsure about a procedure's safety.
Can common ingredients such as alpha hydroxy acids and antioxidants spell trouble for a pregnant woman? Probably not, say experts. Alpha hydroxy acids (glycolic acid, lactic acid) and beta hydroxy acids (salicylic acid) improve the skin's appearance by helping to slough off dead outer layers; antioxidants, such as vitamins E and C, are purported to quell inflammation in the skin and promote a healthier appearance. "Glycolic acid is a natural substance that can be ingested, and lactic acid is fermented milk," says Dr. Draelos.
According to Dr. Reed, these acids belong to category B under the Food and Drug Administration's guidelines, which means either animal studies have shown no harmful effect or, despite unfavorable animal data, human studies do not demonstrate a risk to pregnant women. "You're applying something in a very low concentration," she says.