Skin and Hair Changes During Pregnancy: What to Expect & How to Manage

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“Glowing and growing” and “nine months of good hair days” is something every pregnant woman hears and wants to feel too. However, the coveted ‘pregnancy glow’ and ‘lush tresses’ is not for everyone. If you are one of those fortunate mothers experiencing these – congratulations momma!! Use this time to follow a regular and healthy routine to keep it that way and make it easier post-pregnancy too. If you are on the other side, don’t worry as most of the skin and hair changes during pregnancy are going to improve after delivery as they are due to an increase in the female hormones (estrogen and progesterone).

Skincare in pregnancy

A simple yet effective skincare routine consisting of washing your face with lukewarm water and mild cleanser twice daily, using a good moisturizer, gentle exfoliation, and using sunscreen in all weathers, can go a long way in changing your pregnancy skin game. Other habits like changing towels and pillowcases regularly, adequate sleep and hydration, and decreasing stress also contribute to good skin.

Every woman’s body reacts differently to hormonal changes, while some may not notice any skin changes, others may experience some unpleasant changes like dark spots and pigmentation, dull skin, acne flare-ups, stretch marks, chapped lips, spider veins, varicose veins, dry itchy skin, brittle nails, and increased body hair. Even though temporary, they lead to stress and discomfort for the mother compelling her to try products and medications to treat it. Often, mothers are left wondering, what to do in such situations.

What happens to the skin?	What to do?
Dark spots and pigmentation – ·       Nipples, genitalia, pre-existing freckles, and “moles” darken. ·       Dark blemishes on cheeks, forehead, nose, and chin (Melasma) ·       Dark pigmentation and thick skin in the armpits and groins (acanthosis nigricans) ·       Dark line in the midline of the lower abdomen (Linea nigra)	·       Use a broad-spectrum sunscreen preferably mineral based · Wide-brimmed hat when you are outside.
Itching ·       An itchy rash may develop after 34 weeks ·       Itchy red bumps and large patches on the belly, thigh, buttocks, and arms ·       At times a distressing itch may be due to impaired bile transport and need medical evaluation	·       Creams and lotions (fragrance and harmful chemicals free) ·       Heavy moisturizer routinely during pregnancy ·       Medications after talking to your doctor.
Stretch marks- Can be seen on the belly, breasts, and hips. May appear red, brown, or purple and after delivery, they fade or become whitish but scars remain.	·       Good hydration ·       Moisturization of skin in stretch-prone areas ·       Avoid excessive weight gain (Note: Many products claim to reduce stretch marks but they cannot prevent stretch marks from happening. Many of these products contain retinol, which is harmful to the baby)
Acne and acne marks- Occurs due to the overactivity of oil and sweat glands. Usually increases in the third trimester	·       Use non-comedogenic and fragrance-free makeup products. Remove make-up before sleep. ·       Do not use products with retinoids to treat acne as it causes abnormalities in growing babies. ·       Do not scratch, squeeze, or pull on any growth on the skin ·       See your doctor if the condition is bad and do not take steroid creams without consulting ·       Reduce food intake with large quantities of yeast if you have a fungal infection of the genitalia.
Flaring of skin conditions - Eczema, psoriasis, acne, lupus erythematosus, and candida (fungal) infection of the vagina.
Spider veins - On face, neck, arm, belly, and legs due to greater quantities of blood	Temporary and improve after some months
Varicose veins - May occur in the vulva, vagina, or lower limbs at the end of the second or third trimester.	Shrink or disappear a few months after delivery

Some women experience faster growth of nails during pregnancy while others may experience brittle nails. Nail colors and removers contain chemicals that are toxic and better avoided during pregnancy. Prolonged inhalation of fumes of nail products is also to be avoided in pregnancy.

Piercings on any part of the body, tattoos, and body art are also not recommended during pregnancy. The safety of the ink is not established which can cause allergic reactions. Multiple punctures in the body can cause local infection at the puncture site. There is also a slight risk of blood-borne infections such as HIV or hepatitis B​ or C if the tools used in body art are not properly disinfected.

Due to excessive heat, saunas, steam baths, and hot tubs are also not recommended during pregnancy, especially in the first trimester.

With a myriad of treatment options available in the market, it is necessary to be informed about the effects of products and medications on the baby and take the opinion of a dermatologist or gynecologist whenever in doubt.  Below is a quick reference guide of what you can use and what to avoid during pregnancy.

Use this	Not that
Natural ingredients – Aloe vera, coconut oil, cocoa butter, shea butter, rosehip extract	Retinoids (Label check for tretinoin, isotretinoin, adapalene, tazarotene, trifarotene)- fetal abnormalities Found in some over the counter anti-ageing creams, acne treatment
Azelaic acid, glycolic acid	Benzoyl peroxide, high dose of salicylic acid Used in Acne treatment
Antioxidants like Vitamin C, vitamin E , niacinamide , licorice root , fruit and natural scrubs	Hydroquinone Found in creams used to lighten skin
Fenugreek, neem, gooseberry (amla) masks for hair Use fragrance free products	Phthalates - fetal abnormalities, affects thyroid hormones, sex hormones and Vitamin D level of fetus. Can also cause preterm birth, preeclampsia and GDM. Found in some shampoos, conditioners, hair masks and fragrance.
Azithromycin, Clarithromycin	Doxycycline, minocycline, tetracycline (to be stopped four months before conceiving) - staining of teeth of baby Used in treatment of Acne and other skin conditions.
Mineral based sunscreens (physical sunscreens) with titanium dioxide, zinc oxide	Chemical sunscreens (oxybenzone, avobenzone, octisalate, octocrylene, homosalate or octinoxate
	Formaldehyde (On label check for Formaldehyde, Quaternium-15 , DMDM hydantoin, Imidazolidinyl urea, Diazolidinyl urea, Polyoxymethylene urea, Sodium hydroxymethylglycinate, 2-bromo-2-nitropropane-1,3-diol (bromopol), Glyoxal) - may cause pregnancy loss / cancer Found in some cosmetics like nail polish, hair treatment products, baby shampoos soap etc.

Hair care in pregnancy

Hair growth occurs in three phases - active, resting, and shedding. Most women will experience nine months of good hair days during pregnancy as the extra hormones shift the hair cycle. The hair that grows stays on the head and doesn’t shed. Some women may experience a change in the texture of their hair, and in some women, hair strands may thicken. It is necessary to continue routine haircare with shampoo and conditioner like before. It is usually safe to use prescription anti-fungal shampoo but, prescription cortisone shampoos are not safe. Dry shampoos are also generally safe in pregnancy. Do not comb your wet hair and avoid very tight hair styles. Scalp massages with natural hair oils are said to improve blood circulation and induce hair growth. Oils like almonds, argan, amla, and coconut are considered beneficial and safe during pregnancy. Castor oil should be avoided due to its strong odour and risk of inducing labor as per some reports.

It is better to take a break from dyeing, highlights, perming, and straightening treatments during pregnancy as they may contain formaldehyde. Hair treatments with minoxidil are also not safe to use. While some doctors may have different opinions regarding this due to limited research on the effects of hair styling and chemical treatment on the growing fetus, it is better to avoid unnecessary chemical exposure from these products, especially during the first trimester. There are so many pores on the skin and scalp that, there is always a chance that they can enter the bloodstream via these pores. The fewer the chemicals, the better it is. You can use a flat iron to straighten your hair. Natural dyes like henna are safe to cover your greys. Hair masks using fenugreek seeds, amla-reetha-shikakai mix or neem leaves help in decreasing hair fall, increasing shine, and stimulating growth. Fragrance-free products are usually less on chemicals. As a general rule, it is always better to consult a dermatologist or gynecologist before using any chemical on hair.

Postpartum hair drama begins a few months after delivery. The hair that stayed longer begins to fall out. This can be very heavy and traumatizing for many, but in others can be mild too. Remember this is temporary and you’re not going bald! Simple lifestyle factors like a healthy diet, adequate water intake, and inclusion of nuts and seeds in your diet help restore the health of your hair. Hair growth supplements should always be taken after consulting your doctor.

Hot tip: Soak Garden cress seeds (Aliv /Halim seeds) in water overnight and add to your milk in the morning to prevent post-partum hair fall or you can even make Aliv laddus in ghee. 

Take home message:

Remember, in pregnancy even less is more. There is limited research on the safety profile of chemicals used in skin and hair products. Most of them are isolated cases, some anecdotal, and some documented. So, it is better to stay away from excessive styling and treatments for nine months. Unless mentioned otherwise by your treating doctor, the chemicals mentioned in this chapter are usually safe. However, since the list is not exhaustive it is always better to keep your doctor in the loop. Remember to eat a balanced and healthy diet for good skin, good hair, baby’s health, and yours too.

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