Skincare in Pregnancy: What Stays and What Goes

In short

🔑 The three basic steps stay untouched: gentle cleansing, moisturiser and sunscreen. They are the ones that make most sense now, not least.
What is withdrawn is topical retinoids, and the reason is not demonstrated harm: it is that their risk-benefit balance, on healthy skin, does not justify keeping them.
⚠️ Tretinoin is not a cosmetic: it is a prescription medicine, and there the decision belongs to the doctor who prescribed it, not to a web page.
🔑 If you have already used it without knowing, the figure matters: in 235 pregnancies with first-trimester exposure to topical retinoids there was not a single case of retinoid embryopathy. What did treble was the number of terminations.
Sun protection becomes the priority because pregnancy melasma appears at exactly this point, and pigmentation that has settled in is far harder to treat than to prevent.
🚨 No cream treats a skin disease, and that holds in pregnancy too: if significant acne, rosacea or extensive pigmentation appears, it is assessed in the consulting room and a compatible treatment is chosen.

In pregnancy very little is set aside from a normal routine, and what is set aside is set aside out of caution, not because it has been shown to do harm. The three steps that hold up any routine — cleanse, moisturise and protect from the sun — stay intact, and sun protection becomes even more important than before, because pregnancy is when pigmentation most often appears.

What is withdrawn is the retinoid group, and from there each case is decided by looking at it. That is why this page does not give you a closed list of permitted brands: it explains the criterion and tells you what to ask. And if you have already used something before knowing you were pregnant, there is a study of 235 pregnancies worth knowing about before you spend the night awake.

This page is the answer to the question our skincare routine tool deliberately does not answer: when someone ticks pregnancy or breastfeeding, the tool recommends no product at all and refers you to the medical team. It sits inside the dermocosmetics guide, which explains where what a cream can do comes to an end.

Why this page does not give you a list of brands

Because a list would be more convenient and less honest. A cosmetic product is not an active substance: it is a formulation with twenty or thirty ingredients, and the label says neither at what concentration each one goes in nor at what pH it is formulated. Two creams with the same active on the list may not be comparable.

What can be done — and what we do in the consulting room — is to reason by families of actives: which are always set aside, which stay and which depend on the situation. With that, any product can be classified by reading its ingredients list.

The short list is the one of what is set aside: in pregnancy almost the whole routine is kept.

What is set aside

The retinoids

Retinol, retinal, retinaldehyde, hydroxypinacolone retinoate and vitamin A esters at treatment doses. They are the group with the most evidence of efficacy in photoageing and also the one withdrawn as soon as a pregnancy is confirmed or under way.

The historical reason is solid: oral isotretinoin is teratogenic, with a described and well-documented pattern of malformations. What happens is that this risk has been carried over by analogy to the topical version, and there the evidence is different — we look at it in the next section. Even so, the professional criterion is clear: these are products for healthy skin, there is no urgency about using them for nine months, and they are withdrawn.

On cosmetic retinol it is worth knowing that in Europe it has been limited by law since Regulation (EU) 2024/996: the cap is 0.3% retinol equivalent in a facial product and 0.05% in a body lotion, with a compulsory warning on the pack. It is a general safety restriction, not an authorisation for use in pregnancy. The detail is in retinol concentrations and the European cap.

Tretinoin, which is something else

The topical tretinoin dispensed in Spain — RETIRIDES 0.25, 0.5 and 1 mg/g cream, according to the Spanish Agency of Medicines register — is a prescription-only medicine, not a cosmetic. This is where the page stops: the decision to stop or continue a medicine belongs to the doctor who prescribed it, and this site gives no regimens for medicines. If you are using it and become pregnant, the call is to whoever prescribes it, and you should not wait for the next appointment.

Hydroquinone

It is the classic depigmenting agent and the one the Motherisk review expressly names as an exception: unlike most cosmetics, which act locally, hydroquinone has a relatively high rate of systemic absorption. It is set aside.

The study worth knowing about if you have already used it

It is the most frequent situation of all: someone has been on their retinol for months, takes the test and realises they have been using it through the first few weeks. The question that arrives in the consulting room is not “can I carry on?”, it is “have I harmed the baby?”.

There is a multicentre, prospective study by the European network of teratology information services, published in 2012, which was done precisely to answer that. It compared 235 pregnant women exposed to topical retinoids in the first trimester with 444 unexposed pregnant women. The results, with their confidence intervals:

What they measured	Result (odds ratio)	Significant difference?
Spontaneous miscarriage	1.5 (95% CI: 0.8-2.7)	No
Minor congenital defects	1.3 (95% CI: 0.4-3.7)	No
Major congenital defects	1.8 (95% CI: 0.6-5.4)	No
Termination of pregnancy	3.4 (95% CI: 1.5-7.8)	Yes, three times as many

And one sentence from the authors that is not usually quoted: no child showed features of retinoid embryopathy.

🔑 Read it twice, because it says two things at once. The first: in that series, topical exposure was not associated with more malformations. The second, more uncomfortable: the only thing that trebled was the decision to end the pregnancy, and that was produced by fear, not by the product.

The authors themselves close with the conclusion we endorse and which explains why this page authorises nothing: their results do not suggest an increased risk of retinoid embryopathy, but on current knowledge topical retinoids cannot be recommended in pregnancy, because their risk-benefit balance remains questionable. Withdrawing them is prudent. Agonising over having used them, on what this study measured, is not warranted.

An interval that crosses 1 means no difference has been demonstrated. The only one that does not cross it measures a decision, not a harm.

What stays

Gentle cleansing. Unchanged. If anything, pregnancy is a good moment to make the cleanser less aggressive, because the skin becomes more reactive.
The moisturiser. Unchanged, and probably more needed: itching and dryness are common complaints in these months.
Sunscreen, every day. It is the step that counts most now, because of melasma.
Niacinamide, which is the reasonable alternative when other things are withdrawn and one of the best tolerated.
Mild, occasional exfoliating acids, with the same caution as on any other reactive skin: infrequently and never at the same time as another active.
Topical vitamin C, which is on none of the withdrawal lists.

The Motherisk review sums it up this way for the products it analyses: with the exception of hydroquinone and tretinoin, they act locally and produce minimal systemic levels, so that in most cases these skin problems can be treated without compromising the safety of the foetus. That does not make any particular product “approved”: we choose a formulation by reading its ingredients list, not its advertising.

⚠️ And a point about this section’s title, because it matters: this is not a list of “safe” things, it is a list of “what is not withdrawn here”. Those are different things. If you want to apply the strict criterion — only what has evidence of no transfer — you are entitled to, it is respected without argument and the routine comes down to cleanser, moisturiser and sunscreen. Which is, incidentally, a perfectly good routine.

Pregnancy melasma, which is what almost always brings people in

The symmetrical pigmentation on the cheekbones, forehead and upper lip that appears during pregnancy has a name of its own and a rule worth knowing before spending money: while the hormonal and solar stimulus is still there, no depigmenting agent delivers. What does work now is prevention: generous sunscreen, reapplied, and tinted if possible, because iron oxides hold back part of the visible light.

The treatment of melasma itself — what can and cannot be done, and why it comes back — has its own page: why melasma comes back and when pulsed light is not the answer. And choosing a sunscreen is in how to choose a facial sunscreen.

Breastfeeding

The precautionary principle is the same, with two practical qualifications:

The breast area is a contact area. What is applied there can reach the baby’s mouth, so no actives go on that area: only what is needed for the care of the nipple skin, and that is prescribed by whoever is overseeing the breastfeeding.
On the face, the conversation is individual. With the birth past, the organogenesis argument disappears, but every situation has its context — medication, skin type, what you are after — and it is not a matter for a list.

The house criterion: extreme caution

Here there is a general rule, and it is worth stating in full because it is stricter than what you read almost anywhere. What makes it strict is not a list of prohibitions: it is the order in which the proof is asked for.

🔑 A product can be used during pregnancy or breastfeeding if there is evidence that there is no transfer to the foetus or to the milk. If that evidence does not exist, it is left out. Not because there is any record of harm — for most cosmetics there is none — but because the absence of data is not a safety datum.

⚠️ And it has to be said why this leaves out almost everything. Cosmetics are not tested on pregnant women: it would be unacceptable to do so. So for most actives the honest answer is not “it is safe” or “it is dangerous”, it is we do not know. That is where caution comes in, and caution in these months comes cheap: putting off a serum for a few weeks costs nothing, and it is the one of the two options that does not have to be undone.

In practice, on breastfeeding, that criterion comes down to the two qualifications above: no actives on the breast area, and on the face the conversation is individual — with whatever you are taking and whatever you want to treat on the table.

What the tool does when you tick pregnancy, and why

The skincare routine tool has eight questions, and one of them is whether you are pregnant or breastfeeding. If you answer yes, it shows you no product: it refers you to the medical team for guidance.

It is a deliberate decision by the signatories, and it goes against the tool’s own commercial interest. The reason is simple: the part of a routine that can safely be automated is the part that depends on skin type; the part that depends on a pregnancy depends on data a questionnaire does not have — what week you are in, what your obstetrician has told you, what you are taking, whether melasma is already established. We would rather write to you ourselves than get it half right.

Frequently asked questions

Can I use retinol while pregnant?

No. It is withdrawn during pregnancy and is not replaced by another retinoid: it is replaced with niacinamide or the slot is simply left empty. The reason is not demonstrated harm from the topical version, it is that there is no reason to take on any uncertainty at all on healthy skin for nine months.

I used retinol without knowing I was pregnant — what do I do?

Stop and mention it at your next appointment, without alarm. The largest prospective study on this compared 235 pregnancies exposed in the first trimester with 444 unexposed and found no more malformations or miscarriages, and no child presented features of retinoid embryopathy. If it worries you, write to us and we will talk it through.

And sunscreen? I have read that some filters are not advisable.

Sunscreen stays, and it is the most important step of these months. If you prefer to avoid chemical filters, mineral sunscreens — zinc oxide and titanium dioxide — are a complete alternative. What is not an option is to stop using it: pregnancy melasma appears precisely now.

Can vitamin C be used?

Yes. It is not among the pregnancy withdrawals. If your skin is more reactive than usual in these months, a less acidic formulation may suit, or swapping it for niacinamide, which is what we would do on any sensitive skin.

Can I have a peel or a laser while pregnant?

In-clinic procedures are postponed. This is not a page about medical treatments, but the practical answer is that pregnancy is not the moment: they are planned for afterwards, and in the meantime the work is prevention.

Are exfoliating acids dropped?

They do not have to be dropped, but the frequency does come down and they are not combined. An occasional salicylic or glycolic acid is handled the same way as on reactive skin. The regimen and the legal caps for each family are in exfoliating acids at home.

Is a stretch-mark cream any use?

Moisturising the skin of the abdomen improves comfort and perceived elasticity, and that alone justifies using it. What no cream can promise is to prevent stretch marks, which depend on genetics and on how fast the skin is stretched. Any product guaranteeing that is in breach of the European claims rules.

And if I get acne during pregnancy?

It is common and it is a reason for a consultation, not for a routine. Many of the usual acne treatments are withdrawn in pregnancy, so the safe and effective combination has to be chosen, not improvised.

Sources

Panchaud A, Csajka C, Merlob P, Schaefer C, Berlin M, De Santis M, et al. Pregnancy outcome following exposure to topical retinoids: a multicenter prospective study. Journal of Clinical Pharmacology, 2012;52(12):1844-1851. PMID 22174426. — Prospective study by the European network of teratology information services: 235 pregnant women exposed to topical retinoids in the first trimester against 444 controls. No significant differences in spontaneous miscarriage (1.5; 95% CI 0.8-2.7), minor defects (1.3; 0.4-3.7) or major defects (1.8; 0.6-5.4), and no child with features of retinoid embryopathy. The rate of termination of pregnancy was three times higher in the exposed group (3.4; 1.5-7.8). The authors’ conclusion: the data do not suggest an increased risk, but topical retinoids cannot be recommended during pregnancy because their risk-benefit balance remains questionable.
Bozzo P, Chua-Gocheco A, Einarson A. Safety of skin care products during pregnancy. Canadian Family Physician, 2011;57(6):665-667. PMID 21673209. — A review from the Motherisk programme: with the exception of hydroquinone, whose systemic absorption is relatively high, and of tretinoin, on which the evidence is controversial, the products analysed act locally and produce minimal systemic levels, so that in most cases these skin conditions can be treated without compromising the safety of the foetus.
Spanish Agency of Medicines and Medical Devices (AEMPS), Medicines Information Centre (CIMA). Records for RETIRIDES 0.25 mg/g, 0.5 mg/g and 1 mg/g cream (tretinoin), registration nos. 60140, 60141 and 60142. CIMA. — All three are listed as prescription-only medicines and marketed. It is the boundary between what is decided by reading a label and what is decided by whoever signs a prescription. Consulted on 08-09-2026.
Commission Regulation (EU) 2024/996 amending Regulation (EC) 1223/2009 as regards the use of vitamin A, alpha-arbutin, arbutin and certain substances with potential endocrine-disrupting properties. EUR-Lex. — Annex III, entry 376: a cap of 0.05% retinol equivalent in a body lotion and 0.3% in other products, with a compulsory warning. Applicable to placing on the market from 1-11-2025 and to making available from 1-05-2027.
Regulation (EC) No 1223/2009 of the European Parliament and of the Council on cosmetic products. Consolidated text on EUR-Lex. — Article 2.1(a): a cosmetic has no therapeutic action. It is what separates “moisturising the skin of the abdomen” from “preventing stretch marks”, and what explains why pregnancy acne is a matter for a consultation.

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If you are pregnant or breastfeeding and want to know what to drop and what to keep, write to us: the medical team will go through it with you, free and with no obligation. It is also what the skincare routine tool does when you tick that box, and it does so on purpose.