Retinoids during pregnancy and breastfeeding

This guide reports what each source says about topical retinoids in pregnancy and breastfeeding. It does not tell you what to do. The sources word their advice differently, from "contraindicated" (should not be used) to "data are insufficient", and none of them replaces a conversation with your doctor. If you are pregnant, planning a pregnancy or breastfeeding, talk to a doctor before using any retinoid. It is part of Skinli's guide to retinoids for acne.

What professional bodies say

The AAD says plainly: "Retinoids should not be used during pregnancy." On its acne and pregnancy page, the AAD lists tazarotene among medicines that can cause serious birth defects, and says that if you are pregnant you should stop them immediately. For adapalene and tretinoin it says "Most experts recommend stopping this treatment during pregnancy." It explains why evidence is limited: "Researchers don't give pregnant women medications, so there are no studies to tell us what happens when pregnant women use a treatment."

ACOG, the American College of Obstetricians and Gynecologists, is more detailed. It says: "Unlike isotretinoin, topical retinoids are applied to the skin, and the amount of medication absorbed by the body is low. But it is generally recommended that use of these medications be avoided during pregnancy." It adds that some retinoids can be found in over-the-counter products, so labels should be read carefully.

NICE, in its acne guideline for the UK, says topical retinoids and oral tetracyclines should not be used during pregnancy and when planning a pregnancy. Its table lists the fixed combination of adapalene with benzoyl peroxide as not for use during pregnancy, and the combination of tretinoin with clindamycin as not for use during pregnancy or breastfeeding.

The 2024 AAD acne guideline says: "Tazarotene is contraindicated in pregnancy based on animal reproduction studies, retinoid pharmacology, and the potential for systemic absorption. No human studies have established causal relationships between the use of topical retinoids with birth defects; nevertheless, topical therapies other than topical retinoids are preferred during pregnancy." In that quote, contraindicated means the medicine should not be used, and systemic absorption means absorption into the body. The guideline also says that additional research on the safety of acne treatments in pregnancy and lactation is required. Skinli read the guideline text from a copy archived in March 2025, and a correction notice was published in July 2026 whose content Skinli has not seen.

What the FDA labels say

Labels differ by product, and the differences matter.

• Tazarotene (Tazorac, Fabior, Arazlo): the labels say the medicine must not be used in pregnancy, and the labels call for a negative pregnancy test within 2 weeks before starting.
• Tretinoin: the Retin-A label says to use it during pregnancy only if the potential benefit justifies the potential risk to the fetus. The Retin-A Micro label says published studies have not established a risk of major birth defects or miscarriage, and it lists study limits, including small sample sizes.
• Adapalene: the prescription Differin Gel 0.3 percent label says available data are insufficient to establish a risk. The over-the-counter Differin label says: "If pregnant or breast-feeding, ask a doctor before use."
• Trifarotene (Aklief): clinical trial data have not identified a risk, and the label also mentions case reports of birth defects with other topical retinoids that do not establish a pattern.

Skinli's guide to prescription retinoids for acne puts these in a table.

What the large studies found

A 2015 systematic review and meta-analysis, a study that pools the results of earlier studies, published in the British Journal of Dermatology, pooled 654 pregnant women exposed to topical retinoids and 1375 unexposed women. It "did not detect significant increases in rates of major congenital malformations," which means major birth defects. Its authors wrote that the result may be used primarily in reassuring women who were inadvertently exposed, and also that "the statistical power is not adequate to justify the use of topical retinoids during pregnancy."

A 2026 Nordic register study, which used national health records, of 3,869,586 infants, published in the same journal, found that among infants exposed to topical retinoids, 3.3 percent had a major birth defect (71 of 2172), compared with 3.0 percent among unexposed infants. It reported: "We did not observe an increased risk of MCM associated with use of topical retinoids," where MCM stands for major congenital malformation, a major birth defect. Its plain-language summary still advises: "Given the limitations of our data, topical retinoids should still be avoided in women who are or plan to become pregnant."

If you used one before you knew

MedlinePlus says to call your doctor if you become pregnant while using adapalene or tretinoin. For tazarotene, it says to stop using it and call your doctor immediately. The authors of the 2015 pooled study say their result may be used to reassure women who were inadvertently exposed. Beyond that, no source read for this guide gives a rule for what to do, so the doctor who knows your situation is the right person.

Breastfeeding

LactMed is the National Library of Medicine's drug and lactation database. It says topical adapalene has not been studied during breastfeeding, and because it is poorly absorbed after topical application it is probably a low risk to the nursing infant. It says tretinoin has not been studied during breastfeeding and, because it is poorly absorbed after topical application, is considered a low risk. For tazarotene, LactMed says some experts feel it should not be used on a large surface area while nursing, and others recommend not using it during breastfeeding at all. For all of them, LactMed says not to apply the medicine to the nipple area and to make sure the infant's skin does not touch treated skin. LactMed also states that its information is not a substitute for professional judgment.

MedlinePlus gives the same practical advice for adapalene: apply the smallest amount to the skin and do not apply it directly to the nipple and areola. NICE lists the adapalene and benzoyl peroxide combination as for use with caution during breastfeeding, and the tretinoin and clindamycin combination as not for use. No source read for this guide covers retinol cosmetics while breastfeeding.

What is considered acceptable instead

ACOG says over-the-counter products containing topical benzoyl peroxide, azelaic acid, topical salicylic acid or glycolic acid can be used during pregnancy, and it advises talking with your dermatologist and ob-gyn. NICE recommends benzoyl peroxide alone as an alternative when topical retinoids should not be used, for example during pregnancy. A 2016 review says topical azelaic acid or benzoyl peroxide can be recommended as baseline therapy.

Oral isotretinoin is different

Isotretinoin capsules follow stricter rules. The NHS says you must not take isotretinoin during pregnancy, or if you are trying to get pregnant, because it can cause miscarriage or serious problems with how your baby develops. That rule is for capsules taken by mouth, and the sources above treat creams and gels separately.