Retinol & Over-the-Counter Retinoids
Everyday exposureBeauty & personal careAlso called · 10 names▾▴
retinol pregnancy, retinol serum, retinyl palmitate, retinaldehyde, retinal, adapalene pregnancy, adapalene gel, vitamin A cream, OTC retinoid, retinol breastfeeding
Skin care
General information · effects depend on amount, timing, and how it is used. About these sources
Research strength: 2 / 5
AAD advises avoiding topical retinoids during pregnancy as a precaution. Kaplan et al. and Refsum et al. found no clear major-malformation signal after topical exposure, but their studies do not establish outcomes after planned use. Ask your provider about your situation.
Last reviewed: 2026-10-12
Sources
- ACOG: Skin Conditions During PregnancyProfessional society
- Refsum et al. 2026, Nordic registry cohort
Research strength: 2 / 5
AAD advises avoiding topical retinoids as a precaution throughout pregnancy. Kaplan et al. and Refsum et al. report reassuring observational findings after exposure, but these do not establish that planned use has no risk. Ask your provider about your situation.
Last reviewed: 2026-10-12
Sources
- ACOG: Skin Conditions During PregnancyProfessional society
- Refsum et al. 2026, Nordic registry cohort
Research strength: 2 / 5
AAD advises avoiding topical retinoids as a precaution. Available studies are reassuring for major malformations after topical exposure, but do not cover every pregnancy outcome or OTC retinol use. Ask your provider about your situation.
Last reviewed: 2026-10-12
Sources
- AAD: Acne Treatment During Pregnancy
- Kaplan et al. 2015, meta-analysis
Retinol & Over-the-Counter Retinoids — Breastfeeding
Research strength: 2 / 5
LactMed reports that direct nursing studies are absent and expects low infant exposure from topical adapalene. LactMed advises keeping it off the breast/nipple and away from the baby's skin or mouth. Ask your provider about your situation.
Last reviewed: 2026-10-12
Pregnancy
AAD identifies oral isotretinoin as a medication to avoid during pregnancy, a different exposure from topical creams or gels. MotherToBaby says very little topical acne medication is expected to enter the bloodstream when used as directed; available human studies support counseling after accidental exposure rather than treating it as equivalent to oral isotretinoin. Kaplan et al. (2015) pooled observational studies with 654 topical-retinoid-exposed pregnancies and 1,375 controls. Major congenital malformations were not significantly increased (OR 1.22, 95% CI 0.65-2.29), nor were several other measured outcomes. The authors said the evidence was not strong enough to justify use during pregnancy. Refsum et al. (2026) studied linked Nordic prescription and birth registers covering 3,869,586 infants, including 2,172 with a filled topical-retinoid prescription in the first trimester. Major malformations were recorded in 3.3% of exposed infants (71/2,172), versus 3.0% of unexposed infants and 2.6% of an active-comparator group; adjusted RR was 1.1 (95% CI 0.87-1.38) versus unexposed. Refsum et al. note that a prescription fill does not confirm use or dose, OTC retinol was not measured, and the birth cohort excluded losses before 22 weeks and anomaly-related terminations. These results are reassuring but do not establish the effects of planned use.
Breastfeeding
Direct milk and infant-outcome studies of topical retinoids are lacking. LactMed says topical adapalene has not been studied during breastfeeding; because it is poorly absorbed and blood levels remain below 0.25 mcg/L with long-term use, infant exposure is expected to be low. LactMed advises minimizing treated area and time and avoiding the nipple and infant contact with treated skin.
AAD describes topical retinoids, including adapalene, as acne treatments generally avoided during pregnancy as a precaution. FDA's Drug Facts label identifies adapalene 0.1% as an OTC acne active ingredient. Tretinoin and isotretinoin have separate free SafeMomma entries and are mentioned here only for comparison.
What was tested
Kaplan et al. (2015) pooled observational pregnancy studies, while Refsum et al. (2026) compared filled prescriptions with recorded birth outcomes. A prescription was only a proxy for exposure. The researchers did not measure OTC retinol or actual amount, strength, area and adherence, and early losses were outside the registry analysis.
Precautionary guidance and findings after inadvertent topical retinoid exposure
- Source A says
- AAD recommends avoiding topical adapalene during pregnancy because human data are limited; this is precautionary and distinct from the known risk of oral isotretinoin. (ACOG: Skin Conditions During Pregnancy, AAD: Acne Treatment During Pregnancy)
- Source B says
- Kaplan et al. and the large Nordic cohort have not found a significant overall major-malformation increase after topical exposure, supporting reassurance after accidental use. (Refsum et al. 2026, British Journal of Dermatology, Kaplan et al. 2015, British Journal of Dermatology, MotherToBaby: Topical Acne Treatments)
- Why they differ
- AAD chooses a cautious default when planned-use studies are unavailable. Observational studies are more useful for counseling after accidental exposure than for establishing outcomes after planned use; oral isotretinoin has a different and much stronger evidence base.
- What the evidence shows overall
- Overall, AAD guidance favors precautionary avoidance during pregnancy. Kaplan et al. and Refsum et al. report reassuring findings after topical exposure, but clinicians can help interpret the product, timing, amount and treated area without assuming harm.
- FDA's 2017 Drug Facts label identifies adapalene 0.1% as the active ingredient in the OTC acne gel and advises asking a doctor before use during pregnancy or breastfeeding.
- AAD advises avoiding topical retinoids during pregnancy; clinicians can discuss non-retinoid options for acne or pigmentation.
- MotherToBaby describes sharing the product, strength, timing, amount and treated area with a clinician after accidental use; available data are reassuring for topical exposure.
- FDA labeling for OTC adapalene says to ask a doctor before use during pregnancy or breastfeeding.
- MotherToBaby recommends washing hands after use and keeping treated skin away from the infant; LactMed advises avoiding application to the breast or nipple and limiting infant contact with treated skin.
Not enough research found yet.
Experiences from moms and non-medical voices. Not medical evidence.
Forum posters commonly describe worry after discovering that a retinol product was used before pregnancy recognition; posts often ask whether harm occurred and seek reassurance.
Moms describe stopping retinol after learning about pregnancy guidance, while forum responses differ on concern about topical exposure and alternatives to try.
Collected 2026-10-12
- Refsum et al. 2026, British Journal of DermatologyPrimary
- Kaplan et al. 2015, British Journal of DermatologySecondary
- ACOG: Skin Conditions During PregnancyProfessional societySecondary
- AAD: Acne Treatment During PregnancySecondary
- FDA: OTC Adapalene 0.1% Drug Facts labelDrug company labelSecondary
- MotherToBaby: Topical Acne TreatmentsTeratology serviceSecondary
- LactMed: AdapaleneUS governmentSecondary
- AAD: Pregnancy Skin Care GuidanceSecondary
Last reviewed 2026-10-12
Independent check in progress
Not yet clinician-reviewed
Ask your provider about your situation.