Retinol and Pregnancy: What the Safety Evidence Says

The standard advice is to stop retinol and other retinoids as soon as you are pregnant, and ideally while you are planning a pregnancy. The American Academy of Dermatology (AAD) recommends avoiding prescription and over-the-counter products containing retinoids, including tretinoin, tazarotene and retinol. The reassuring part is that large studies of topical retinoids have not found a rise in birth defects. If you used retinol before you knew you were pregnant, the evidence is encouraging, and your clinician can advise you on next steps.

Below we explain why the advice exists, what the research shows, what to do after accidental use, and how to keep your skin looking its best with ingredients that suit pregnancy.

TL;DR

• Major dermatology and medicines bodies advise avoiding topical retinol and other retinoids during pregnancy, as a precaution.
• Large studies of topical retinoids in early pregnancy have not shown a significant increase in major birth defects or miscarriage.
• Oral isotretinoin is a different matter: it carries a well-established risk, and you should stop it and call your provider straight away if you may be pregnant.
• Azelaic acid, glycolic acid, niacinamide and daily SPF are the usual swaps while you wait.
• If you are planning a pregnancy, ask a clinician when to pause your routine and what to replace it with.

Table of Contents

• What the major bodies advise
• Why retinoids are avoided in the first place
• What the studies show about topical use
• What if you used retinol before you knew you were pregnant?
• Retinol before pregnancy: when to pause
• Other vitamin A and retinoid names to look for
• What to use instead of retinol
• A simple pregnancy-friendly routine
• Our perspective
• Plan your routine with a clinician
• FAQ
• Sources

What the major bodies advise

The advice is consistent, even where the underlying evidence is more nuanced.

• AAD (United States): Retinoids should be avoided during pregnancy, covering prescription acne treatments such as isotretinoin, tretinoin and tazarotene, and over-the-counter products with retinol or adapalene, because they can put a baby at risk of birth defects.
• European Medicines Agency (EU): In its 2018 statement, the EMA said that for topical retinoids systemic absorption is negligible and fetal harm is unlikely. Even so, as a precaution it contraindicates them in pregnant women and in women planning a pregnancy.
• UKTIS (United Kingdom): The UK Teratology Information Service notes that sporadic case reports of malformations exist, but larger cohort studies have shown no increased risk. It says use during pregnancy is not generally recommended.

The common thread is caution. Regulators and clinicians choose the simplest rule, avoid retinoids, because there are good alternatives and no benefit to taking a chance.

Why retinoids are avoided in the first place

Retinol is a form of vitamin A, and retinoids are its relatives, including tretinoin, tazarotene, adapalene and retinaldehyde. Taken by mouth in high doses, vitamin A derivatives such as isotretinoin are known to cause serious birth defects. That is why isotretinoin comes with strict pregnancy-prevention programmes. In the United States, the March of Dimes explains that if you become pregnant while taking isotretinoin, or within one month after stopping it, your provider must report it to iPLEDGE and the FDA.

Topical products are used in a very different way. Only a small amount reaches the bloodstream through the skin. The caution has carried over from the oral drugs to creams and serums because nobody wants to run a trial on pregnant women, and because clinicians prefer a clear rule to a calculation of doses.

What the studies show about topical use

This is the part many people find reassuring. Several analyses have looked at women who used topical retinoids in the first trimester.

A large Nordic study, reported by ABC News in 2026, found no evidence of increased birth-defect risk in babies exposed to topical retinoids during pregnancy, even as use of these products rose sharply over two decades. Its authors described it as the strongest evidence to date on the question.

The 2026 Frontiers authors still acknowledge remaining uncertainty, and the same paper notes that the EMA and Australia’s TGA continue to advise against topical retinoids in pregnancy as a precaution. So the honest summary is this: the evidence is reassuring, the official advice is still to avoid, and the sensible approach is to follow the advice and not worry unduly if you have already used a product.

What if you used retinol before you knew you were pregnant?

Many pregnancies are discovered a few weeks in, so this is one of the most common worries. Here is a calm way to approach it.

1. Stop the product. Put your retinol, tretinoin or retinaldehyde product aside from today.
2. Do not panic. The Frontiers meta-analysis says its findings may provide reassurance for women who were inadvertently exposed to topical retinoids early in pregnancy, and that clinicians should explain that the available evidence shows no increased risk while acknowledging some uncertainty.
3. Tell your midwife, obstetrician or GP. Mention what you used, how often and for how long. UKTIS notes that an individual risk assessment is advised if very high doses were used or if factors that increase absorption were present, and that additional ultrasound assessment may sometimes be considered.
4. If it was oral isotretinoin, act at once. Stop taking it and call your prescriber straight away, as the March of Dimes advises.

One US dermatologist quoted by Vogue put it plainly: suspend every retinoid once you learn you are pregnant, including retinol and retinaldehyde, even though these topical products have not been shown to cause birth defects. That is the balance to keep in mind.

Retinol before pregnancy: when to pause

The EMA’s position covers women who are planning a pregnancy, not only those who are already pregnant. Beyond that, we are not aware of an authoritative, universally agreed number of weeks for topical products, and the answer depends on the product and your own history. Oral isotretinoin has its own formal waiting period set by your prescriber.

If you are trying to conceive, the practical approach is to plan the swap in advance. Skin often needs a few weeks to settle on a new routine, and starting that before a positive test means you are never caught out. A clinician can map this out with you in a few minutes, and our online skin consultation is built for exactly that kind of planning.

Other vitamin A and retinoid names to look for

When you check a label, retinol is only one of the names. On the ingredient list, watch for:

• Retinol, retinaldehyde (retinal) and retinyl palmitate or other retinyl esters
• Tretinoin, the prescription form
• Tazarotene and adapalene
• Isotretinoin, which is taken by mouth

The AAD also lists other ingredients to avoid in pregnancy, including hydroquinone, and oral medicines such as tetracycline-class antibiotics, spironolactone and finasteride. It suggests discussing high-strength salicylic acid (above 2%), benzoyl peroxide and parabens with your doctor. Our guide to ingredients to avoid in skincare goes through the wider list.

What to use instead of retinol

You do not have to give up on results. These are the swaps we most often discuss with pregnant and trying-to-conceive clients.

Azelaic acid

Azelaic acid helps with redness, breakouts and uneven tone. Medical News Today reports that it has an FDA pregnancy rating of B, and that experts generally suggest using it no more than twice daily at a maximum strength of 20% during pregnancy.

Glycolic acid

For dullness and rough texture, a gentle exfoliating acid can stand in for retinol. A Canadian review of skin care products in pregnancy concluded that topical glycolic acid should not be of concern, because only a minimal amount is absorbed. The AAD recommends SPF 30 or higher whenever you use an exfoliating acid, as noted by Medical News Today.

Niacinamide, vitamin C and daily SPF

Niacinamide supports the skin barrier and helps with oil and tone, while a daily sunscreen protects against the pigmentation changes that many people notice in pregnancy. Our clinician-written guide to pregnancy skincare with azelaic acid, niacinamide and daily SPF sets out how to layer them. If melasma is your main concern, see our pregnancy-safe pigmentation guide.

A note on bakuchiol

Bakuchiol is often called a gentler plant alternative to retinol. Ask a clinician before relying on it in pregnancy, and read our comparison of bakuchiol and retinol to see how a 12-week trial can be judged.

A simple pregnancy-friendly routine

1. Morning: gentle cleanser, niacinamide or vitamin C serum, moisturiser, then broad-spectrum SPF 30 or higher.
2. Evening: gentle cleanser, azelaic acid (on its own or in a moisturiser), then a barrier-supporting moisturiser.
3. Once or twice a week, if your skin is dull: a mild glycolic acid product, with sunscreen the next morning.

Introduce one new product at a time and wait a week or two before adding another. Pregnancy can make skin more reactive than usual, so patch testing on the inner forearm is sensible.

Our perspective

We see this question every week, and the reaction is usually worry, not curiosity. Our view is that the evidence deserves to be shared in full: official bodies advise avoiding retinoids in pregnancy, while the research on topical use is reassuring.

That combination is exactly why a personalised plan matters. A clear, clinician-guided routine removes the guesswork, and it means that skin concerns such as pigmentation, acne or redness do not go unmanaged for nine months. We build routines around pregnancy-compatible actives and daily protection, then plan the return to prescription-strength skincare afterwards.

Our clinic team works with UK-trained doctor Dr. Mandy Mak, and our virtual consultations let you talk through your skin, your plans and your products without leaving home, wherever you are in the world.

Jess

Plan your routine with a clinician

If you are pregnant, planning a pregnancy or breastfeeding, a one-to-one conversation is the quickest way to a routine you can trust. Book an online skin consultation and we will review your current products, flag anything to pause and suggest alternatives. You can also browse our skincare categories, including serums, moisturisers and sunscreens, to find the building blocks of a simple routine.

FAQ

Can you use retinol during pregnancy?

The official advice is no. The AAD and the EMA both recommend avoiding topical retinoids, including retinol, during pregnancy as a precaution. Studies of topical use have not shown a significant rise in birth defects, but avoidance remains the standard recommendation.

Is it safe to use retinol before I knew I was pregnant?

The evidence is reassuring. A 2026 meta-analysis of more than 3.6 million pregnancies found no significant link between topical retinoid exposure and major malformations or miscarriage. Stop the product and mention it to your midwife or doctor, who can advise you on your own situation.

Is vitamin A in skincare the same as oral vitamin A?

No. Topical retinoids absorb in very small amounts through the skin, while high-dose oral vitamin A derivatives such as isotretinoin carry a recognised risk to the baby. If you take isotretinoin and may be pregnant, stop it and call your provider right away.

What can I use instead of retinol while pregnant?

Azelaic acid, glycolic acid, niacinamide and a daily SPF 30 or higher are the usual choices. Introduce them one at a time, and ask a clinician if you have a specific concern such as melasma, acne or rosacea.

How long before trying to conceive should I stop retinol?

The EMA advises against topical retinoids in women planning a pregnancy, so the safest approach is to switch to a pregnancy-friendly routine before you start trying. The exact timing depends on the product, so ask your clinician or prescriber.

Sources

• AAD: Dermatologist-approved pregnancy skin care
• EMA: Updated measures for pregnancy prevention during retinoid use
• UKTIS: Use of tretinoin in pregnancy
• March of Dimes: Isotretinoin and other retinoids during pregnancy
• Kaplan et al. 2015: Pregnancy outcomes following first-trimester exposure to topical retinoids
• Frontiers 2026: Topical retinoids and risk of major congenital malformations
• ABC News: Retinoids are booming in the beauty industry
• Vogue: Best retinol alternatives during pregnancy
• Bozzo et al.: Safety of skin care products during pregnancy
• Medical News Today: Retinol alternatives

Recommended

• EU Retinol Ban: What You Need to Know
• When to See a Clinician After a 12 Week Retinol vs Bakuchiol Trial
• Clinician Approved Pregnancy Skincare: Azelaic, Niacinamide, Daily SPF