Ask Apothaka: what products can I use in pregnancy?

I'm back with a common question I'm asked by customers - are Apothaka products pregnancy-safe? The short answer is yes! As of this time, none of my products contain ingredients which are contraindicated in pregnancy. That said, I'm currently working on an exciting product that will be the only one unsuitable for use in pregnancy (more to come on this at a later date!).

I wanted to share a bit more about what to expect with your skin during pregnancy and what to avoid, as when I've replied to customers, they have really appreciated the additional information I've provided.

So let's start with how the skin can change. We often hear about the "pregnancy glow", but sadly not all of us may experience this! As we know, fluctuating hormones are the cause of a lot of skin changes throughout someone's life (e.g. puberty and menopause / peri-menopause). Pregnancy is no different, as it's a key state in which hormones are going through significant change in a relatively short period of time. Skin that is usually oily can become dry and flaky, and vice versa. For some, pregnancy can result in an exacerbation of existing acne particularly in the first trimester; or it can appear in previously clear skin. Others may experience an improvement in acne. The skin can also become more sensitive than usual so changes to your usual skincare routine may be required.

A very common effect of hormonal changes is the appearance (or worsening) of melasma (often known as the "mask of pregnancy"), which can occur in 15-70% of pregnant women and is caused by melanin overproduction triggered by hormone fluctuation. Melasma is most common in women with Fitzpatrick skin types III and IV. It presents as brown patches of skin, typically on the face (usually the forehead, cheeks and upper lip), though they can occur elsewhere (I still have melasma patches on my inner upper arms as a result of being on oral contraceptives decades ago - I haven't done anything to treat them as they don't really bother me there!). Melasma is quite difficult to treat (especially when pregnant as some of the treatments are contraindicated in pregnancy) so prevention is absolutely crucial, especially in pregnancy. As melasma is worsened by UV exposure (as well as heat), this means that diligent sun protection is an absolute must every day (and by that I mean a dedicated sunscreen, NOT make up with SPF), but sun avoidance is key i.e. seeking shade, wearing UPF hats, clothing and sunglasses, and not actively sitting / lying in the sun. In short, don't rely on sunscreen alone to prevent melasma occurring/ worsening if you already have it. 

So what ingredients should be avoided during pregnancy? It's important to understand that data is very limited, as clinical studies cannot be conducted on pregnant women, so when dermatologists advise against the use of certain ingredients, it's either based on data from animal studies, from anecdotal reports of women having used these ingredients during pregnancy, or a known contraindication with the oral version of the ingredient (e.g. oral isotretinoin is known to be teratogenic) and is therefore quite cautious, which is a good thing if you're a worrier, like I was in my pregnancy.

The general guidance is to avoid the following ingredients and I would always recommend discussing these ingredients with a healthcare professional first):

• all retinoids (retinol, retinal, tretinoin, adapalene, oral isotretinoin etc typically used to treat hyperpigmentation / melasma but can't be used in pregnancy and oral isotretinoin can't be used during breastfeeding either)
• hydroquinone (typically used to treat hyperpigmentation / melasma but can't be used in pregnancy / breastfeeding)
• alpha-arbutin (typically used to treat hyperpigmentation / melasma but is often not advised in pregnancy / breastfeeding)

Ingredients to use with caution:

• salicylic acid: it's generally considered safe when used for a limited time and depending on the area of exposure (using it on a small area of your face at a 2% max concentration vs a large area of your body). You might prefer to use a rinse off version (e.g. a salicylic acid cleanser) to reduce exposure. Best to check with a healthcare professional first

Ingredients considered safe to use in pregnancy (though keep in mind the skin may be more sensitive than usual to products):

• sunscreen: as mentioned above, it's really important to keep using this (chemical or mineral sunscreens are considered safe). Bonus tip - visible light from the sun can cause hyperpigmentation but iron oxides (the colour pigments used in make up products and tinted sunscreens) can help prevent pigmentation. This is one of the main reasons why I like to use a tinted moisturiser over my sunscreen every day!
• AHAs (lactic / mandelic acid / glycolic acid): stick to lower concentrations (under 10%), and bear in mind your skin may be more sensitive than usual to actives. Glycolic is potentially the most irritating of these so lactic and mandelic are probably better options in pregnancy
• PHAs: a gentler alternative if AHAs feel too aggressive for you
• enzymes: a gentler alternative to acids listed above, love these!
• azelaic acid: this is seen as a good alternative to treat acne during pregnancy (instead of retinoids) and can also be helpful for rosacea, though some clinical papers suggest waiting until after your first trimester
• benzoyl peroxide: - considered safe in limited amounts. Best to use short contact therapy / wash off treatment (i.e. a cleanser with BPO) and check with your healthcare professional first
• vitamin C (ascorbic acid), niacinamide, kojic acid: these can be helpful in managing hyperpigmentation/melasma, or at least prevent it from worsening and are considered fine to use in pregnancy if your skin tolerates them
• hyaluronic acid: though not an exfoliating acid, I thought it was worth mentioning here as some people confuse it with exfoliating acids (it's not - its purpose is hydration)! This is fine to use in pregnancy
• physical exfoliators (with particles to buff off excess skin cells, or even soft, clean washcloths): as long as you choose something with super fine particles and are not aggressive in applying it to your face, then this is an alternative to chemical exfoliators like AHAs / PHAs. I don't advise using them on active acne lesions though as you're likely to further inflame and irritate the skin.

What about essential oils? It's true that certain essential oils are contraindicated in pregnancy, however the vast majority of these are not the oils you'd typically find in skincare products. Specifically, the essential oils used in my formulations (fragranced cleansing oils and face oils) have been cleared by a chemist as safe for use in pregnancy - especially given the relatively small surface area being treated (the face represents one ninth of your overall body and this is how toxicologists calculate the safety of ingredients in cosmetics. If you're very worried, then you could always wait until after the first trimester to start using essential oils. 

That's probably quite a lot to take in if you're pregnant and trying to figure out what skincare you should be using! But keep in mind that aside from the ingredients you should avoid in pregnancy, the same principles I always talk about still apply here - the goal is skin health, which comes from our skincare "holy trinity": a basic routine of

• gentle but effective cleanser
• a moisturiser suitable for your skin's needs (more occlusive for dry skin, less occlusive for oily skin) 
• a daily dedicated sunscreen

Then if you have specific concerns (acne, hyperpigmentation, rosacea), you would add 1-2 targeted treatments on to this routine.

I had my daughter nearly 14 years ago (before I started Apothaka!) and can't for the life of me remember what skincare I was using then, but here's how my skincare routine would have looked at that time if I knew then what I know now about skincare. For reference, I was 34 at that time, my skin was fairly balanced at that time (leaned a bit more combo / oilier in summer), I wasn't regularly using actives and I tended only to get hormonal spots. I was fortunate that my skin didn't change much during pregnancy (though I developed mild comedonal acne a few years later).

Morning routine:

• rinse with water
• barrier support serum + barrier defence AOX (to prevent hyperpigmentation)
• skin quenching moisturiser
• EVY daily UV mousse SPF30 (winter) or daily defence mousse SPF50 (summer)

Evening routine:

• comforting cleansing oil (winter) or gentle cleansing gel (summer)
• barrier support serum (+ gentle enzyme exfoliant a couple of times a week)
• skin quenching moisturiser

As needed to treat spots: benzoyl peroxide directly on the spots only (I prefer 2.5% but this is hard to get in the UK for some reason but I pick it up when I'm in India!)

Obviously, it's important to tailor your routine to your own concerns but this hopefully gives you an idea of how to adapt your skincare routine when pregnant. For the purposes of this post, I have just focused on topical skincare, but it's also worth thinking about professional (in-clinic) treatments that can or can't be used during pregnancy. It would be worth consulting an experienced aesthetician (ideally one with a focus on skin health) for these.

If you're currently pregnant, I wish you a happy and comfortable pregnancy! If you have any further questions about the products mentioned and their suitability for pregnancy, please get in touch! At Apothaka® because of our thoughtful focus on overall skin health, we can help to support the entire hormonal spectrum (teens vs pregnancy vs peri-/menopause)!