Let's face it: Despite the joy and anticipation of bringing a new life into the world, pregnancy can make you feel downright dowdy. Besides your expanding waistline, your appearance takes a hit in lots of other ways. The mélange of hormones your body has cooked up to promote your baby's growth can wreak havoc with your complexion, cause your skin to discolor, and trigger hair growth in places you've never seen it before. It's only natural that you'd want to remove those unsightly strands, have your nails done, or try a new hair color. But could that dye or depilatory be risky to your developing fetus?
Unfortunately, it's not always clear if a product or treatment is baby-safe. "We have lots of questions, but not too many answers," says Gerald Briggs, a clinical pharmacist at Women's Hospital, Long Beach Memorial Medical Center, and coauthor of Drugs in Pregnancy and Lactation. "There are virtually no studies done during pregnancy."
Yet researchers have gleaned much about the safety of cosmetics from animal studies and the thousands of pregnancies each year that are unplanned -- some 50 percent of all pregnancies. "Women may be taking a medication or getting exposed to a chemical weeks before they learn they are pregnant. The follow-up of those cases can yield important information," explains Gideon Koren, M.D., a professor of pediatrics, pharmacology, and medicine and medical genetics at the University of Toronto and director of Motherisk, a service providing information about substances that cause birth defects (teratogens), at the Hospital for Sick Children, in Toronto.
In fact, "with proper caution and common sense, you can maintain your looks throughout pregnancy," says Barbara Reed, M.D., a dermatologist at the Denver Skin Clinic who specializes in the safety of dermatology drugs during pregnancy. "I think it's important not to deny yourself something just because you are pregnant."
Here's what researchers have uncovered about the hair, skin, teeth, and body treatments you may be pondering to perk up your pregnancy. (When in doubt about any product or treatment, consult with your physician.)
Beth Howard is based in Asheville, North Carolina.
Good news: You don't have to abandon hair dyes and highlights throughout most of your pregnancy. Coloring agents can pass through the scalp and into your bloodstream, but in such minute quantities that they are generally thought to be harmless to a developing fetus. The data is limited but suggests that hair color doesn't cause birth defects or other problems -- even among people who work with it regularly, such as beauticians, says Dr. Koren. What's more, "you're not going to have many exposures during pregnancy," adds Zoe Diana Draelos, M.D., a dermatologist in High Point, North Carolina, who also studies cosmetics and skin medications. Still, due to the lack of direct data, Dr. Koren often advises women to avoid coloring their hair during the first trimester, when the baby's organs are developing.
Animal studies show that hair permanents and straighteners don't cause abnormalities in offspring, but there have been no studies involving people. "Research conducted in the 1980s suggests that people who work with products have higher rates of miscarriage, but the increase seems to be due to the physical aspects of the job -- such as standing for long hours -- rather than the chemical exposure," Dr. Koren says. More recently, researchers at the Centers for Disease Control and Prevention found that the risk of having a preterm- or low-birth-weight baby was no higher for a group of African-American women who had used a hair curling or straightening product during pregnancy or within three months of conceiving than for those who had not used these products.
Keep in mind, however, that pregnancy can make these hair treatments less effective -- and even a waste of money. "Hormones can do strange things," says Sandra Johnson, M.D., director of dermatology research at the University of Arkansas for Medical Sciences, in Little Rock. "You may not get the results you're used to."
But there may be another concern. In recent years some investigators and environmental groups have called attention to a class of chemical additives called phthalates, which are contained in many cosmetic products, including hair gels, sprays, and nail polish. Some phthalates have been linked to developmental problems in animals, especially to the male reproductive system, according to Jane Houlihan, vice president for research for the Environmental Working Group (EWG). A recent study from Columbia University confirmed that pregnant women are routinely exposed to these chemicals in the environment, and Italian researchers found that exposure appears to shorten pregnancy slightly.
Still, no one has linked a particular cosmetic or product to pregnancy problems or to abnormalities in newborns. "We have not had enough good solid research and data gathering," says Briggs. Tim Long, Ph.D., a toxicologist at Procter & Gamble, which makes scores of cosmetic products, argues that most contain only tiny doses of phthalates and an individual's exposure is minimal. "Many of the harmful effects these groups are citing come at extremely high doses," he says. Briggs agrees that while phthalates have suspected toxicity in humans, any potential hazard probably has more to do with repeated exposure (the chemicals are found in everything from medical devices to food packaging) than with the use of cosmetics alone. "They're so spread out in the environment," he says, "that they're hard to avoid."
If you want to steer clear of phthalates in beauty products until more is known, however, only use the products that the EWG has tested and found to be phthalate-free, such as Physique Extra Control Structuring Gel and Aussie Mega Styling Spray. (For a list, go here and here.)
Getting rid of hair -- the unwanted variety, that is -- is of far less concern, says Dr. Reed. "I don't know of any contraindications to bleach, depilatory, laser hair removal, or electrolysis during pregnancy."
And there's no reason to go around with alabaster arms and legs this summer if you don't want to. Self-tanners, made of the active ingredient dihydroxyacetone, are basically dyes that stay on the skin's surface and are safe to use when you're expecting. "The available data do not support an association between its use and problems with the baby," says Dr. Reed.
Tanning is not advised: It can worsen melasma ("the mask of pregnancy"), patches of discolored skin that often appear on the forehead, cheeks, and upper lip during pregnancy, due to a woman's high hormone levels. And, of course, tanning increases your risk of skin cancer, whether or not you are pregnant.
Having a massage can be a great way to relieve the stress and discomforts of pregnancy -- and may even enhance your unborn child's well-being. "Massage reduces stress hormones, and because of that, it may lower the risk of premature birth," says Tiffany Field, Ph.D, director of the Touch Research Institutes, in Miami.
Pregnancy massage is usually performed while you're lying on your side, with the focus on your back and legs. It's important that a therapist avoids your feet, however, as stimulating the back of the ankle and the Achilles tendon can stimulate contractions, says Field. Most properly trained massage therapists know to avoid this area in pregnant women, but some treatments -- including pedicures -- may involve a foot rub by untrained personnel. Ask your cosmetician to avoid your ankles or skip this extra frill. If smells are bothering you, request unscented oils.
Even short stints in the sauna and hot tub can raise your temperature to unhealthy levels, so most experts advise avoiding them during pregnancy. A temperature above 101°F in early pregnancy can cause miscarriage and defects of the neural-tube system, according to the Organization of Teratology Information Services (OTIS). A safer way to get glowing: Stay hydrated and follow a regular pregnancy-safe exercise plan.
Wearing perfumes or fragrances requires another judgment call. According to Dr. Reed, "There are no reported incidents of fetal toxicity with fragrances." Yet, according to Houlihan, most contain phthalates. If you want to be 100-percent safe, avoid perfume until after childbirth.
Phthalates may also be present in lotions and deodorants. Curel Soothing Hands Moisturizing Hand Lotion, Vaseline Intensive Care Dry Skin Lotion, and Dove Powder Anti-Perspirant are on the EWG phthalate-free product list.
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.
While teeth bleachers and whiteners are safe for most people, there's no research on their use during pregnancy, according to Kimberly Harms, spokesperson for the American Dental Association, who recommends pregnant women avoid bleaching.
But you can cross nail polish off your list of maternal worries. "Nail polish is not a problem, because the nails are not a living tissue," says Dr. Draelos. Polishes briefly release volatile chemicals into the air when they're being applied, however. Prolonged exposure to these chemicals -- such as that experienced by people who work in industries that use them -- is associated with malformations, but the occasional, brief exposure involved in painting your nails is not considered harmful. Polishes also often contain phthalates -- products that are free of these chemicals include L'Oréal Jet Set Nail Enamel and Revlon Nail Enamel.
It's easy to worry about what could go wrong with your baby-to-be. But remember that the vast majority of birth defects have nothing to do with unsafe drugs or chemicals. "Women shouldn't become martyrs in pregnancy," says Dr. Koren. "They should have a normal, healthy life." Follow your doctor's pregnancy advice, and chances are, your baby will be healthy too.