Program: Lab Notes: Skincare, pregnancy and a minefield of mixed messages

Jonathan Webb: Pregnancy is a hell of a time. It's a wonderful rite of passage, of course, but oh my goodness, do you get some advice? Things to do, things not to do, foods to avoid. But what about stuff that you put on yourself, like skincare products? Everyone uses them from sunscreen to deodorant, but it turns out the advice on what's safe during pregnancy can be messy and even downright contradictory. We're going to look at one ingredient in particular, which points to something of a bigger problem. This is Lab Notes from ABC Radio National. I'm Jonathan Webb. Now I've been a hopefully supportive partner during two pregnancies, but I'm very glad that today I'm joined by two people with much more firsthand knowledge of this stressful period of life. They're both actually currently expecting. So welcome and congratulations to health reporter, Caitlyn Davey.

Caitlyn Davey: Hello, thank you.

Jonathan Webb: And to Lab Notes' own producer, Fiona Pepper.

Fiona Pepper: Thanks, Jonathan.

Jonathan Webb: So we're talking about a group of chemicals called retinoids, which Caitlyn's been looking into, but this story actually started out with you, Fiona. What happened?

Fiona Pepper: So late last year when I found out I was pregnant, I told my sister and she was happy, but she quite quickly said, are you still using retinol on your face? And I said, yeah. And she said, well, stop. And I did some Googling and she was right. Retinol is not recommended for use by pregnant women. And then I came to work and I was speaking to a colleague who's also pregnant and she had had a very similar conversation. She'd written to her doctor saying, hey, can I keep using retinol through pregnancy? And her GP said, absolutely not. And it made me wonder, why isn't there any warnings on these skincare products, particularly when the target market for these products is women of childbearing age. And as a pregnant woman, there are a lot of things that I'm told I shouldn't be doing. So it felt strange that there was just sort of no sign of that anywhere on the packaging.

Jonathan Webb: It just wasn't on the list of the already very many things that you should probably stop using while you're pregnant.

Fiona Pepper: Yeah, soft cheese, whatever. Even the protein powder that I have been taking, there's a warning on the back saying, don't take this if pregnant and consult your doctor first. My question is, why aren't there warnings when it comes to skincare products with retinoid?

Jonathan Webb: And so you brought this to our colleagues in the science unit, including health reporter, Caitlyn Davey, who started to look into it. What did you find out, Caitlin? What are these retinoids? They come in a few different flavours, don't they?

Caitlyn Davey: Yeah, so this is why it's so confusing because retinoids are vitamin A derivatives. So they come in different forms. And vitamin A, we also get in food, mainly fish, eggs, dairy, and liver. Retinol is the most famous one, I would say, or the most popular at the moment in the skincare aisles. There's also the likes of tretinoin, adapalene. One expert I spoke to called them the gold standard of skincare because they have so many benefits. But you break these down into three different categories and that's why it's confusing because there's the oral tablets, there's the topical prescription creams, and then there's the over-the-counter creams.

Jonathan Webb: Okay, what does the evidence say about these different types and the risks?

Caitlyn Davey: One of the biggest things I've found is there's just this massive void of information when it comes to pregnant women and different medications. We know for certain oral retinoids are not recommended. So that's brands like Roaccutane is quite well known. These are to treat severe acne and they have proven to create birth defects.

Jonathan Webb: Okay, so people know to stop taking those during pregnancy. But then we get to the other two categories. What do we know about the ones you can be prescribed to rub on your skin?

Caitlyn Davey: Commonly, this might be tretinoin is one of the best known ones. And these are not necessarily recommended, but there is evidence that use of those has not created birth defects.

Jonathan Webb: Okay, so people have done studies and they haven't found that there is a link, but I guess the cautious advice might still be to stop using them if you can.

Caitlyn Davey: Yeah, and they're clearly labeled both of those, the oral and the prescription topical. They both have labels of not suitable for pregnant women. You can't get them without a prescription. So your healthcare provider would have conversations with you about that. But it's, yeah, the over the counter ones that we can buy in the supermarkets or the chemist, that's where the waters get muddied.

Jonathan Webb: I guess the over the counter ones, they might be slightly different ingredients and also the concentrations, the dosages are a bit lower, are they? And is there any data on whether they're safe or whether they're at risks?

Caitlyn Davey: There's not a lot of data on these because they kind of get swept to the side because of the prescription ones and the studies there are already lacking. So then the over the counter even less, but typically retinol, which is in your over the counter ones, that's a much gentler derivative rather than your tretinoin or your isotretinoin. Adapalene is a bit of an outlier. That was one that was schedule four, but downgraded to schedule three by the TGA, which found that 150 times the maximum daily topical dose showed no teratogenic effects.

Jonathan Webb: Okay, so although there's not much data overall, the TGA, our Therapeutic Goods Administration here in Australia felt confident enough to say that there's no evidence of teratogenic effects, no birth abnormalities. That's for Adapalene, which is one of the non-prescription over the counter retinoids, but it still carries a warning and it's still schedule three, which means you need to talk to a pharmacist about it. What about the other retinols, the freely available ones? Is there any science on those at all?

Caitlyn Davey: There was a large Nordic study that came out last year that looked at 3.8 million births and it found there's been a 3.3 fold increase in use of topical retinoids and found there was no major increase in birth defects, which is quite reassuring, I think, for people who may have used them unknowingly that there aren't negative outcomes.

Jonathan Webb: So they've just looked over time and tracked that these things have increased, but there's no sort of parallel increase in negative outcomes for the births? Correct. Okay, yeah, that is reassuring. So does that suggest that if people are hearing this or like Fiona, they're hearing from friends who are also pregnant that they really maybe should have stopped if they're taking a cautious approach using some of these products, if they haven't stopped, do we think they should be worried?

Caitlyn Davey: Look, everyone I spoke to, their health practitioners all said, I have advised patients to avoid it out of an abundance of caution. However, if you have used it, we don't wanna spark panic. The risks are pretty low, particularly for retinols because they're much lower doses. So you've got MotherSafe New South Wales, which says over-the-counter are okay to use. And I spoke to Dr. Michelle Wong, who's a chemist, and she said, even if you've used a prescription once or twice, that shouldn't be cause for concern.

Jonathan Webb: Okay, that is good to hear. But if MotherSafe New South Wales says they're fine and people are maybe hearing from their GPs that they should stop, there is this thing again, where the advice can be a bit contradictory and confusing for expecting mums, right?

Caitlyn Davey: That is something in my pregnancy I've learnt is true for all medications. The TGA has 1,700 listed approved medications and only 150 are marked as safe for use for pregnant women. So there's just this mountain of lack of information for pregnant women to be using any cosmetics or medications.

Jonathan Webb: And so I guess best to talk to a GP if you're worried or curious about a particular ingredient or a particular preparation that you are using and whether or not it's safe.

Caitlyn Davey: Yes, definitely. That was the theme from all the experts was speak to your maternal health provider. The other thing Dr. Wong said was they should be fine provided they're used as recommended. So we don't wanna pick up on some social media trend where you're slathering your body with face serum. But if you're using it as prescribed in these over-the-counter doses, it should be fine.

Jonathan Webb: Okay, what have you learned overall from doing this research? Has it changed anything in your behaviour or pointed to any particular gaps you think in the regulation or the advice that people receive?

Caitlyn Davey: Not all retinoids are made equal is the big learning here. I think your retinol serum with its 1% is not gonna have the same effect as taking a tablet of isotretinoin. But yeah, I stopped using my retinol serum just as a precaution, because I thought, why not? One less thing to worry about.

Jonathan Webb: And that often is the advice in this realm, isn't it? Is if you can avoid it while you're pregnant, then caution first is often the way people provide this advice.

Caitlyn Davey: Yeah, if in doubt, leave it out.

Jonathan Webb: Yeah, which does then mean as a pregnant mum, you get pretty fed up with being told to stop yet another thing, but here we are. Caitlyn and Fiona, thank you for sharing your lab notes with me on this topic.

Caitlyn Davey: Thank you so much. Thanks, Jonathan.

Jonathan Webb: Caitlyn Davey is our health reporter in the Radio National Science Unit. You can find her online article about retinols during pregnancy on the ABC News website. We'll put a link in the show notes. This episode of Lab Notes was produced on Gadigal, Menang Noongar and Jagera and Turrbal country. It was mixed by Antonia Gauci. I'm Jonathan Webb. I'll catch you next week.