If you've built a skincare routine that works, finding out you need to ditch one of the key ingredients is frustrating. And retinol is usually the first thing on the "stop using this" list when you're pregnant or trying to conceive.
The short version: you do need to take it seriously, all retinoids should come out of your routine, and there are good alternatives that won't leave your skin in pieces.
Let's break it down.
What retinol actually is
Retinol is a form of vitamin A. It's one of the most well-studied and effective skincare ingredients out there, used for everything from anti-ageing and acne to evening out skin tone and boosting cell turnover. It works by encouraging your skin to shed old cells faster and produce new ones.
The term "retinoids" is the umbrella category. It includes prescription-strength options like tretinoin (Retin-A) and isotretinoin (Accutane), as well as over-the-counter forms like retinol, retinal (retinaldehyde), and retinyl palmitate. They all convert to retinoic acid in the body, just at different speeds and potencies.
Understanding the difference matters, because the risk level isn't the same across the board.
Why retinoids are a concern during pregnancy
Vitamin A is essential for fetal development, but too much of the active form (retinoic acid) can cause serious birth defects. This is called teratogenicity, and it's one of the most well-established findings in reproductive toxicology.
The clearest evidence comes from oral isotretinoin (Accutane), which is taken systemically for severe acne. Oral isotretinoin is a known teratogen. It can cause craniofacial, cardiac, and central nervous system defects. This is not a grey area. It is genuinely dangerous during pregnancy, and anyone prescribed it is typically required to use two forms of contraception and take regular pregnancy tests.
Oral tretinoin (used in some cancer treatments) carries similar risks.
Topical retinoids (the creams and serums most people actually use) are absorbed through the skin in smaller amounts than an oral dose, but they are still retinoids and they still convert to retinoic acid in the body. There are case reports linking topical tretinoin use during pregnancy to birth defects, and while large studies haven't been able to prove a statistically significant increase in risk, no one has run (and no one ever will run) a controlled trial deliberately exposing pregnant people to retinoids to find out for sure.
Every major dermatology body still says to avoid topical retinoids during pregnancy. So do we. The potential consequences for a developing baby are severe and irreversible, the alternatives are easy, and "we couldn't prove harm" is not the same as "it's safe." PregSafe always errs on the side of caution here.
What about retinyl palmitate and other derivatives?
Retinyl palmitate is a weaker, more stable form of vitamin A that shows up in a lot of moisturisers, SPFs, and "gentle" anti-ageing products. It converts to retinol, which then converts to retinoic acid, so it's several steps removed from the active form.
While the risk is lower than from tretinoin or retinol, it still converts to retinoic acid in the body, and most experts recommend avoiding it during pregnancy. The same applies to other vitamin A esters like retinyl acetate and retinyl linoleate.
If a product lists retinyl palmitate on the label, the safest approach is to swap it out. Alternatives are easy to find, and it's not worth the uncertainty.
Alternatives that actually work
You don't have to just accept worse skin for nine months. There are effective alternatives for most of what retinol does.
A quick note before the list: bakuchiol gets recommended all over the place online as a "natural" retinol swap during pregnancy. We don't recommend it. It's on PregSafe's limit list for three reasons: it has confirmed estrogenic activity in lab studies (it binds to estrogen receptors), no pregnancy safety studies have been done on it, and the ingredient supplier itself doesn't endorse pregnancy safety claims. Until that data exists, the cautious call is to skip it and use one of the options below instead.
Azelaic acid. Generally considered safe during pregnancy (it's actually prescribed for rosacea in pregnant patients in some countries). It helps with acne, pigmentation, and uneven skin tone. If retinol was your acne fighter, azelaic acid is your best bet.
Vitamin C (L-ascorbic acid). Great for brightening, antioxidant protection, and supporting collagen production. It won't replace retinol's cell-turnover effects, but it covers the "glow" side of things nicely.
Niacinamide (vitamin B3). Helps with pore size, uneven skin tone, and skin barrier health. It plays well with other actives and is safe during pregnancy.
Alpha hydroxy acids (AHAs) at low concentrations. Glycolic acid and lactic acid in leave-on products at low percentages (under 10%) are generally considered fine. They can help with the exfoliation that you're missing from retinol. High-concentration peels are a different story, so check with your provider.
For a deeper look at reading skincare labels during pregnancy, see our guide on what "fragrance" really means on your skincare label.
What about when trying to conceive?
This is where it gets personal. If you're actively trying to conceive, most dermatologists recommend stopping retinoids before you get pregnant, not after you find out. The reason is simple: the most critical period for fetal development is the first few weeks, often before you even know you're pregnant.
For topical retinol and retinaldehyde, stopping when you start trying (or a month before) is generally considered sufficient. These clear from your system relatively quickly.
For prescription topical tretinoin, the same guidance usually applies. Stop before you start trying.
For oral isotretinoin, the guidance is much stricter. You should stop at least one month before trying to conceive (some guidelines say longer), and your prescribing doctor will have a specific protocol for this.
If you've already used a retinol product before you knew you were pregnant, don't panic, but do stop now and flag it to your healthcare provider or dermatologist. They can talk through your specific situation and any follow-up that might be sensible.
The bottom line
Oral retinoids during pregnancy are clearly dangerous. Topical retinol is almost certainly lower risk than that, but "lower risk than a known teratogen" is not the same as safe, and the responsible advice (ours, and every major dermatology body's) is to avoid all retinoids during pregnancy and while TTC. The alternatives, azelaic acid, vitamin C, and niacinamide, are genuinely effective and easy to switch to.
The hardest part isn't giving up retinol. It's figuring out which of your products actually contain it, especially when it's listed under different names or buried in a long ingredient list.
That's one of the things PregSafe is built to help with. Scan a product, get a clear answer. Join our waitlist to be the first to try it.
PregSafe is not a replacement for medical advice. Always consult your healthcare provider or dermatologist for personalised guidance about your skincare routine during pregnancy.
