Pregnancy can be both a beautiful and a bewildering time. While watching your belly grow and decorating your baby’s nursery may land on the thrilling end of the spectrum, skin changes often fall firmly in the bewildering camp. While some lucky people may experience that elusive “pregnancy glow” 24/7 for nine months, most will have to deal with at least some unwelcome skin side effects on their face, body, and even nipples and vagina (yep).
It's helpful that more people are beginning to open up about these experiences, including celebrities like Drew Barrymore (who struggled with melasma), Ashley Graham (who has showed off her stretch marks), and Alicia Keys (who dropped some helpful tips for clearing up pregnancy acne). But the more information you have, the better able you are to prepare.
With the help of two dermatologists and an ob-gyn, we have you covered on everything you should expect when it comes to your skin during the pregnancy and postpartum periods.
An Unexpected Bout of Acne
Most people know that pregnancy requires you to ditch hot tubs and soft cheeses, but you may also need to reconsider your skincare routine. Even if you rarely experienced the pain of acne in your pre-baby life, it’s still possible that you’ll have breakouts during pregnancy. While acne can happen during any trimester, it is often more prevalent during the first and second when your body increases its production of androgen hormones like testosterone, which cause the skin to produce more sebum. More oil leads to more pimples.
Treatment is further complicated during this time as many go-to acne-fighting favorites like retinol and salicylic acid aren’t safe to use. Dermatologist and Veracity advisor, Dr. Angela Lamb, says that pregnancy-safe skincare ingredients that are safe to use to combat acne during pregnancy include azelaic acid, topical clindamycin, and L-ascorbic acid (vitamin C).
Hyperpigmentation & Linea Nigra
No, you’re not seeing things—discoloration can occur in the most intimate of places during pregnancy. You may be admiring your pregnant belly one day and notice that your nipples suddenly look darker or that you now have a dark line extending from your belly button to your pelvis. Your labia may also darken, notes Dr. Alyssa Dweck, ob-gyn and advisor to Veracity.
Our normal skin coloring is determined by the amount of a substance called melanin in our skin. During pregnancy, the rise of estrogen and progesterone levels can stimulate an excess production of melanin, which can lead to these darker spots in surprising areas.
This is the same reason that many pregnant women develop melasma (also known as “the mask of pregnancy”), a darkening of the skin in patches anywhere on the body, but most commonly on the face.
“Pigment changes may be permanent, or they may lessen over time,” Dr. Dweck says. “I don't think it's fair to say that they'll ever completely disappear. Some people may try some sort of skin bleaching procedure, which is a little aggressive. Some people may try exfoliative care.”
While getting rid of pregnancy melasma may be difficult, you may notice that any spots that have developed begin to lessen in intensity once you stop breastfeeding.
The most important thing to keep in mind when it comes to treatment is to be vigilant about sun protection to prevent your melasma from getting worse. As Dr. Dweck says, “Keep that skin out of the sun, even intimate skin these days.” Dr. Lamb echoes this sentiment, saying the best thing to prevent melasma and hyperpigmentation is to “be compulsive” with sunscreen. “Use sun-protection, particularly a metal-based blocker (like zinc or titanium) and wear a hat.”
This may be hard to hear given all the pregnancy advice blogs out there, but you can put down the Bio-Oil. All three of the doctors with whom I spoke said exactly the same thing: nothing can prevent stretch marks.
“Stretch marks are totally genetic. There’s nothing that you can do to prevent them. Nothing,” Dr. Lamb says. “People ask me all the time what to do about stretch marks, but you either get them or you don't. It actually doesn't have a ton to do with weight gain. There are people who gain a ton of weight [and have] no stretch marks, and vice versa.”
While moisturizing religiously isn’t going to prevent stretch marks from appearing (you can thank your parents if you are one of the lucky ones), if they bother you, there are things you can do post-pregnancy to make them less noticeable.
“Once you have them some ablative treatments like Fraxel laser and deep microneedling or stamping may help lessen them,” says Dr. Sandy Skotnicki, dermatologist and author of Beyond Soap. Dr. Lamb says that, after you are finished breastfeeding, Tretinoin (a prescription form of retinol that is not safe for use during pregnancy) can help build-up collagen in the skin, making stretch marks less noticeable.
Breast & Intimate Skin Changes
You have probably gone through your entire life without knowing the name “Montgomery’s tubercles” — and then you got pregnant. This formal name is what the sebaceous glands around your nipples that look like little whiteheads are called. Everyone has these glands and they’re often visible even on people who are not expecting, but they may become more noticeable during pregnancy.
“Sebum is released from oil or sebaceous glands. It is well known that sebum helps keep the skin acidic and therefore decreases skin infection,” says Dr. Skotnicki. “[Montgomery’s tubercles] also help lubricate and keep germs away from the breasts during breastfeeding.”
Dr. Dweck notes that pregnancy can also change the architecture of the breast, which isn’t a skin change per se, but it could affect how your breasts look. More collagen and tissue in the breast could make the skin feel lumpy.
She also notes that there will likely be changes to the vaginal skin in the postpartum period, particularly for women who are lactating. “Their intimate skin is going to become super delicate, dry, and very thin because of hormone changes related to very low estrogen levels; many [postpartum people] have not returned to ovulation yet.” You may even notice that your labia look flatter than normal, a sign of dehydration. If this is causing you discomfort, apply a vaginal moisturizer to the delicate skin, and use lubricant when having sex to prevent pain.
Skin Tags or Growths
“Pregnancy is a very proliferative time, so [pregnant people] tend to get new growths. You might notice skin tags or vascular growths called cherry angiomas, which are really common,” Dr. Lamb says.
Estrogen is thought to play a role in the formation of skin growths, though one 2019 study also found a link between the hormone leptin and the prevalence of skin tags during pregnancy (leptin is significantly increased in the body during this time). The important thing to know is most of these pregnancy-related growths will shrink or disappear after giving birth.
Rashes & Itchy Skin
Even if that body butter may not prevent stretch marks, it can help ease the itchy, dry skin that is so common during this time. Increased itching in pregnancy is caused by both your hormonal fluctuations and your skin stretching and becoming taut. This can sometimes result in the outrage that is itchy stretch marks.
In more extreme cases, some may also experience pregnancy dermatosis (aka rashes). While annoying, these rashes are usually a result of — you guessed it — hormonal changes. They can also be caused by stretching skin, blood flow, and genetics. If the rash or itching gets intense, treat it with a Benadryl or hydrocortisone cream or try taking an oatmeal bath.
So much about pregnancy can feel unexpected. The refrain with one physical revelation after another is often, “How did no one ever tell us about this?” But when you know what’s in store when it comes to your skin, you can be prepared for the more baffling pregnancy changes so that you can appreciate the delightful experiences — we’re looking at you, glow – even more.