It seems there’s a wives’ tale for everything during pregnancy, including acne. Maybe you’ve heard this one: “You’re breaking out! It must be a girl—they steal your beauty.” Or, “Your skin is glowing; clearly, it’s a boy.” These are just some of the well-intentioned, but poorly thought-out things people say to expectant moms. But is there any truth to them? Does pregnancy really affect your skin in that way?

You can’t predict your baby’s gender based on your breakouts, but, yes, your skin can change when you’re with child. That can mean acne (even if you’ve never experienced it before) or possibly a clearing if your skin is typically acne prone. We talked to Julie C. Harper, M.D., founding director of the American Acne and Rosacea Society and Acne Store Advisory board member to find out what you can expect from your skin when you’re expecting.

Let’s first talk about hormonal acne

Before we tackle pregnancy, it’s important to wrap your head around the hormonal component of acne. “All acne is hormonal,” says Harper. Whether you’re a teenager, an expecting mother, or a 40-something woman with a that-time-of-the-month zit, your hormones are at the root of all of your pimples.

Researchers still don’t fully understand the inner workings of hormones and your breakouts, but they know that when your hormone levels are in flux (such as puberty or during a woman’s menstrual cycle), breakouts are more likely to happen. Another one of those times can be pregnancy. The hormones mainly at play here are estrogen, progesterone, and androgens (male hormones, including testosterone). Hormones can increase sebum production, the oil pumped out by the sebaceous glands. Hormonal imbalances can also trigger inflammation, and hormones also play a role in the clogging of your pores. Excess oil, inflammation, and blocked pores are the perfect storm for pimples.

Researchers know that when your hormone levels are in flux (such as puberty or during a woman’s menstrual cycle), breakouts are more likely to happen.

Why am I getting so many pimples while pregnant?

Acne during pregnancy may stem from the increased progesterone that occurs when a woman is carrying a child. In fact, it’s well known that progesterone-only oral contraceptives can often make acne worse in women. Some experience breakouts in the first trimester, when progesterone first surges. Others see facial and body bumps in the latter parts of pregnancy when your progesterone level peaks. One recent study in the International Journal of Dermatology found that while severe acne is less common during pregnancy, those who are already experiencing bad breakouts on their face or trunk tend to get it in the third trimester. [1]

Pregnancy can also help acne

Then there are women who say their acne got better when they were expectant moms, including Harper. “I had horrible acne growing up, and in pregnancy I had some of the best skin of my life,” she says. Why some people get a reprieve from their acne during pregnancy isn’t so clear.

How can you treat acne during pregnancy?

“This is the hard part,” says Harper. There are some medications, such as topical and oral retinoids (think isotretinoin, the active ingredient in Accutane), that aren’t safe to use during pregnancy. That means the toolbox of treatments for pregnancy acne is a little more limited. But there are still some effective options, Harper says. So, what can you use? Harper turns to an ABC mnemonic for pregnancy-safe acne treatments.

A is for azelaic acid, which helps clear pores and calm inflammation without any harmful side effects for pregnant women. You can find it under the brand name Finacea. B stands for benzoyl peroxide. This topical kills acne-causing bacteria and takes down inflammation. Short-term use is generally considered safe during pregnancy but talk to your doctor first. And clindamycinis is the C. This topical antibiotic slows the growth of acne-causing bacteria and is generally considered safe for pregnant women. If those three options don’t work, Harper says she adds an E: Erythromycin, an oral antibiotic that’s considered safe for short-term use.

Post-pregnancy, acne should get better

Once you deliver and your progesterone levels start to normalize, your pregnancy acne should begin to fade. If you’re breastfeeding and still seeing blemishes, you can use one of the treatments mentioned above, as they’re also safe for nursing mothers. Still, contact your doctor before starting any acne medication while breastfeeding.

References:

[1]: https://onlinelibrary.wiley.com/doi/abs/10.1111/ijd.14999#:~:text=Severe%20acne%20during%20pregnancy%20is,characteristics%20with%20female%20adult%20acne