Guidance for wearing sunscreen to reduce the risk of skin cancer holds true during pregnancy as well, but there are other reasons to keep sunscreen as a part of your pregnancy skincare routine. Read more...
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Choosing the right form of sunscreen application during pregnancy
What should you look for in terms of the type of application- stick vs lotion vs spray?
When should a pregnant person apply sunscreen during pregnancy?
Lastly, are there any pregnancy-safe sunscreens that you'd recommend? Can you share why for each?
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Why is sunscreen so important during pregnancy?
Guidance for wearing sunscreen to reduce the risk of skin cancer holds true during pregnancy, however there are other reasons to keep sunscreen as a part of your pregnancy skincare routine. Hormones from pregnancy can increase the risk of pigmentation of the skin known as melasma. The interaction between hormones and light sources such as UV and blue light can trigger pigmentation in exposed areas. While treatments exist for post-pregnancy pigmentation, prevention through adequate photoprotection measures is often more effective.
The other thing to remember is that severe sunburns and even sun poisoning can lead to a systemic or whole-body response to excess UV. This can result in fluid shifts and imbalances that can place the fetus at risk.
Are there pregnancy-safe sunscreens?
I don't know that I have ever seen a label on sunscreen that specifically stated it was safe during pregnancy. However, when we hear about sunscreen safety concerns, the ingredients we tend to focus on are ones that have the potential for endocrine disruption. Knowing this, let's go through each known sunscreen ingredient to help you decide for yourself which may be best to choose. See below for a comprehensive table.
There are two main categories of sunscreen ingredients: physical and chemical.
Physical Sunscreen Ingredients
Physical sunscreens typically contain zinc oxide and/or titanium dioxide. While zinc oxide and titanium dioxide are generally regarded as safe and effective (GRASE designation) by the FDA. The challenge faced with use of these ingredients is that they do not tend to be cosmetically elegant to apply. Both can leave a white cast behind and my patients often find that they are difficult to wash off. For this reason, many companies use the nanoparticle versions of these sunscreen ingredients.
When you see the word "nano", "micronized", or "invisible" with the use of physical sunscreen ingredients titanium dioxide and/ or zinc oxide, this means that the particle is extremely small to make it less noticeable when applied. The challenge faced with the nanoparticle formulations is that there is conflicting data in the medical literatures with regard to whether these ingredients can be absorbed through the skin based on how small the particle. Remember that these nanoparticles are also found in foods, paints, toothpaste, and other cosmetic products. There is a higher risk of exposure to the nanoparticle forms by ingestion or inhalation compared to absorption. However with practical use of these products, remember that if you are swimming with these sunscreens on, the product may wash off in the pool and run the risk of ingestion as well. Nano-Zinc oxide has been shown in laboratory studies to have the potential for toxicity to our cells, toxicity to our genes, neurotoxic, and can be harmful to development. Studies have shown the risks associated with titanium nanoparticles during fetal development in inhibiting the developing of the lungs and heart and potential toxicities to the nervous and reproductive systems.
Choosing a mineral sunscreen product that specifies that the non-nano form of zinc oxide and/or titanium dioxide is used is one way to avoid this concern. This is also important to know because some sun-protective clothing brands actually embed zinc oxide into the textiles to make the textile sun protective. This process often uses the nano-Zinc oxide form. This has not been well studied in terms of its impact on our health if the nano-Zinc is released from the garment over time through sweat, washing, or swimming. Choosing sun protective clothing that specifies that no UV chemical finishes were used is key to avoiding this issue.
Chemical Sunscreen Ingredients
In 2019, there was a significant study published in JAMA demonstrating significant absorption into the bloodstream of chemical sunscreen ingredients after one day of use. This study was particularly impactful for pregnant women given that another study demonstrated a statistically significant jump in Google searches for terms “sunscreen for pregnancy,” “safe sunscreen pregnancy,” “sunscreen pregnancy,” “sunscreen lactation,” “safe sunscreen breastfeeding,” and “sunscreen nursing.” Given that the risk of absorption appears to correlated with the body surface area over which the sunscreen is applied, it may make sense to limit the use of chemical sunscreen products to the face and/or hands and focus on the use of sun protective clothing made without UV chemical sunscreen ingredients, hats, and seeking shade.
Choosing the Right Form of Sunscreen Application
There are a wide array of sunscreen products available such as sprays, lotions, sticks, and powders. Sunscreen sticks are convenient and often use mineral-based formulas, while lotions and sprays vary widely. When opting for sprays, be mindful of inhalation risks associated with aerosol application, especially during pregnancy. It is rare but possible to find a sunscreen spray that uses mineral sunscreen ingredients. This is for the simple reason that mineral sunscreens tend to be thicker resulting in blockage of the nozzle.
Is it best to choose a water-resistant sunscreen?
Water-resistant sunscreens contain additional ingredients to enhance adherence to the skin, such as acrylates, silicone, and polymers. These should have a minimal to low risk of absorption. During pregnancy, it is ideal to limit overall exposure to unnecessary ingredients if alternatives can be found. However, bear in mind that during pregnancy you may be more likely to sweat which will make a routine sunscreen less effective in certain circumstances.
Is it best to choose products for sensitive skin?
Skin sensitivities to sunscreen are usually a result of the active ingredients, the preservatives, and/or any fragrances added. From an active ingredient perspective, limiting to physical sunscreen ingredients such as zinc and/or titanium can help reduce irritation. Choosing sunscreens that are fragrance-free is also helpful.
Is sunscreen safe to use during pregnancy?
During pregnancy, it is best to rely on a combination of various sun-protective behaviors to reduce the need for excess sunscreen use. Using sun-protective clothing, hats, sunglasses, umbrellas, shade, and avoidance of peak sun hours can allow for limited usage of sunscreen products. Chemical sunscreens have been shown to be absorbed into the bloodstream with unclear risk to health. Using physical sunscreens such as zinc and/or titanium tends to be favored for this reason.
Why is chemical sunscreen not safe during pregnancy?
There have been associations made between chemical sunscreens and the possibility of endocrine disruption. Studies have confirmed that chemical sunscreens are absorbed into the bloodstream with the amount absorbed dictated by the body surface the sunscreen is applied. There are unclear risks associated with this absorption, however, for now, the belief is that the known risks of excess UV exposure outweigh the unknown risks potentially associated with chemical sunscreen ingredients. Also take into consideration the amount of sunscreen used and where it is applied. Limiting application to the face and/or hands should limit risks of excess absorption given the smaller body surface area of the application.
When should a pregnant person apply sunscreen during pregnancy?
Ideally applying sunscreen at the beginning of the day for a “layer of protection” followed by reapplication midday if outdoors is best.
Lastly, are there any pregnancy-safe sunscreens that you'd recommend? Can you share why for each?
I personally tend to recommend sunscreens that have zinc and/or titanium as active ingredients. As discussed above, limiting the body surface area that sunscreen is applied to should minimize the risk of potential absorption. This would make most sunscreens safe to use. However if you are truly seeking sunscreens that meet the criteria for being mineral sunscreens such as zinc oxide and/or titanium dioxide in the non-nanoparticle form, the link below is a curated list of options. Interestingly, many of these are not mainstream brands of sunscreen.
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