Skin During Pregnancy and Postpartum: What’s Going On?

Pregnancy and postpartum is a time of profound change within the body, and that certainly is true for skin function. Changes during this time are common, whether skin becomes symptomatic for the first time, underlying skin symptoms surface, or, more positively, the coveted ‘pregnancy glow’ reveals itself. We often hear from clients that they’re unsure, confused, and sometimes even fearful of skin symptoms arising during pregnancy and postpartum, especially if they’ve had issues in the past. We want to help alleviate that fear. By trusting and supporting your body’s innate intelligence (instead of constantly trying to “fix” it), you can appreciate this time as the truly phenomenal experience it is. After all, humans have evolved to do this over many millennia – the body rarely needs your brain’s interference.

Our Approach

At Marie Veronique we focus on education because if we understand why something is happening, we can better cope with supporting and/or treating it. We trust that changes aren’t always bad, nor do they always result in prolonged symptoms. That perspective makes them a little easier to deal with. 

In our practice of working with clients as an esthetician and an acupuncturist, we see a wide range of hormonal influences on the skin, from factors such as irregular cycles and hormonal imbalances, fertility goals and treatments, pregnancy and postpartum, menopause, and beyond. An important distinction in how we approach hormonal imbalances is that we view them as having an indirect impact on skin function, that is, they typically are not the sole reason or cause for unwanted symptoms. Instead of viewing fluctuating hormones as a problem, we find that leaving the hormones alone and supporting the organ systems allows the body to balance hormones naturally. 

That said, the pregnancy and postpartum time frame is extremely unique in the sense that the profound hormonal changes do influence the system and skin function (we will tell you why). In this post, we’ll go over the four phases of pregnancy and postpartum, which will help you understand the changes your body and skin are undergoing; then we’ll talk about the common skin concerns people experience during pregnancy; and finally, we’ll give you some advice and suggestions for how you can support your body and your skin during this time.

The Four Phases of Pregnancy and Postpartum

From a skin perspective, we consider there to be four major transition phases of pregnancy and postpartum: first trimester; second and third trimester; post-birth/breastfeeding; and post-breastfeeding. Here’s a brief look at what’s happening during each phase on an internal and hormonal level, and how the skin is affected.

Phase 1: First Trimester – "Excess"

The volume of blood increases, the immune system is suppressed to protect the embryo, and increased pregnancy hormones flow through the blood system. Additionally, the endocrine system secretes an increase of hormones that stimulate vascular growth and changes to the vascular system. Histamine levels are also highest during the first trimester (and then very low in second and third trimesters), which is why it’s common to experience histamine symptoms in the respiratory system (itchy, stuffy “allergic” reactions) and, potentially, histamine triggers in the skin.

Overall systemic levels of inflammation are also high during the beginning stages of pregnancy, due to implantation and hormone changes, which may result in skin changes as well. Changes to the digestive system (nausea, bloating, food aversion, heartburn, etc.) can also lead to skin changes, such as increased oil production in the skin (breakouts), inflammatory response in the skin, swelling, redness and flushing, microbial changes in the mucous membranes (dermatitis, nasal congestion), and fluid retention. 

During the first trimester, intestinal microflora remains similar to that of your pre-pregnancy microbiota (which is hopefully robust, depending on your gut health) but pH levels of the vaginal biome do start to shift, which means that women are more vulnerable to pathogenic activity such as yeast infections (locally) and yeast overgrowth on the skin.

Phase 2: Second and Third Trimester – "Ease" 

Estrogen and progesterone levels continue to rise, but the body has a better ability to adjust and find its course (and the placenta starts to play a major role!). However, this does remain a phase of obvious fluctuations. Increased hormone levels can stimulate rapid hair growth (not always where you want it, and/or ‘blocking’ pores resulting in breakouts), as well as pigment changes in your skin. Cortisol levels also continue to rise, as well as water retention, all of which has the potential to affect skin. 

There is good news for the skin during this time: inflammation levels decrease mid-pregnancy to protect the fetus, and that continues until birth. Additionally, if you’re able to support your system and ease its hormonal transitions, this is the phase where you may experience the coveted  ‘pregnancy glow,’ as balanced hormone levels can add a natural blush to the skin’s surface.

This is a very important time to support microbial function, both internally and topically, as microbial diversity in both the gut and oral mucous membranes steadily declines until birth. If microbial function is not supported during this time, it can result in starting the postpartum period with a more vulnerable immune and digestive system (during an already highly vulnerable time). A few other changes that are common and relate to skin function include sweat gland changes, skin tags, bleeding gums, and other oral issues. The goal at this time is to support the “ease” of changes and transitions so that symptoms do not have to become problematic for the skin.

Phase 3: Postpartum Period – "Depletion"

Birth! This phase starts with the ultimate high – adrenaline, oxytocin, increased blood volume, new baby, etc. – but quickly shifts to a state of depletion for your body. Around 3-5 days after birth, hormones sharply decline, and so does sleep, as cortisol and prolactin levels increase. Additionally, milk production for breastfeeding adds a new demand on the system. This highly variable phase makes sense in the grand scheme of things – your body is going through big changes to allow you to care for your baby – but the drastic swings can result in skin symptoms. 

The shift of nutrients from mother to baby can lead to dry skin, increased inflammation, and a decrease of blood flow to the surface of the skin. As mother and baby adjust to all the changes, the body remains in a state of flux as the system attempts to find new balance. Additional factors that can impact skin during this time include continued changes to the hair follicle, changes to thyroid function, and changes toadrenal function in response to fatigue. 

It is extremely important to support and restore your system to the best of your ability during this time to avoid depleting your body even further. Systemic depletion impacts skin function significantly, and can result in a sudden surge of inflammatory and immune conditions including rosacea, dermatitis, eczema, dandruff, acne, dull skin, and other signs we may interpret as ‘aging’ skin.

Phase 4: Post-Breastfeeding/Menstrual Cycle Returns – "Renewal" 

During this phase, your body starts reducing the production of prolactin, which signals the pituitary gland to produce estrogen and stimulate the ovulation process, which in turn leads to the return of your period. New surges of hormones can again make the body symptomatic, especially if it's depleted of vitamins and minerals (e.g. Vitamin D, Vitamin B, iron/ferritin, selenium, zinc, magnesium, EFAs). For many women this stage is welcome, as more estrogen means more collagen! Collagen production alleviates that depleted look caused by loss of elasticity that many complain of while breastfeeding, helping the skin resolve and replenish itself. This really can be a phase of renewal for the body and skin if you support yourself correctly. You can think of it as an opportunity to sort of “reset” your system and begin anew. 

Common Skin Concerns During Pregnancy and Postpartum

If the above is a map of what's happening on an internal level, what exactly does that mean for the surface of the skin? Here are the most common skin conditions that we see throughout pregnancy and postpartum:

• Breakouts. Enlargement of sebaceous glands and an increase in sebum (from excessive signals) can create clogging in the follicles. This creates an environment in which pathogenic bacteria, ‘acne bacteria’ (Propionibacterium acnes), can thrive, leading to more inflammation and infection, i.e. a “pimple.” Typically we see an increase of breakouts in our clients during the first trimester; for those with pre-existing acne, it can worsen, and for those who never break out, they can still see a surge of oil production and blemishes. This can appear across the face, neck, chest, back, and buttocks/thighs. For most, many symptoms are alleviated in the second trimester, as breakouts subside and healthy skin is revealed. 

• Inflammation. Similar to breakouts, we see many clients experience an initial surge of inflammation in the skin, which manifests as dermatitis, eczema, psoriasis, and/or rosacea, and which quickly resolves in the second and third trimester. Considering the surge of inflammation, histamine, hormones, and the suppressing of immune function throughout the body, this all makes sense. However, as the body continues through the pregnancy and inflammation levels decrease, most of these symptoms resolve. This offers a moment of relief especially for those who experience them even when they are not pregnant. 
• Sensitive skin. The combination of the rise of histamine during the first trimester with the hormonal shifts that influence inflammation in the skin and an increase in heat in the system can make one's skin hypersensitive to touch, pressure, etc., as well as heightened senses (smell!). As inflammation decreases and blood circulation stabilizes, heightened sensitivity decreases, and the skin can become very calm and resilient. 
• Increased hair production on face/head. Not only do we grow more hair on our scalp, but many women also start producing hair along the jawline and upper lip. This happens in response to hormone changes, and typically resolves as hormones reset postpartum.The hair may also be thicker, which can contribute to clogged pores and appear as breakouts along the jawline. 
• Puffiness/water retention. In relation to rising progesterone levels, your system may respond by retaining more water during pregnancy. This can result in swollen ankles/feet, legs, hands, and facial swelling, especially at the end of the day. Swelling may fluctuate throughout pregnancy and can worsen immediately after birth due to medications or fluid IVs, but should resolve quickly. Be sure to incorporate movement (walking, hikes, yoga, dancing, etc.), hydration, and healthy eating habits to help regulate. 
• Melasma and hyperpigmentation. Elevated levels of estrogen and/or progesterone can stimulate the melanocytes to produce excess melanin, resulting in pigmentation of the skin cells. This is common in pregnancy, often manifesting as new spots on the face, a ring around the mouth/upper lip (“mustache”), more freckles, and a thin, dark line (linea alba) over the belly. Most of this new pigmentation resolves on its own post pregnancy, but that can take up to a year or more, depending on the individual. Our advice to clients is to not worry about this pigmentation, as most topicals that reduce pigmentation are not safe for use during pregnancy. Instead try to appreciate it as a temporary change and even a special ‘mark’ of pregnancy.
• Body skin changes, including stretch marks. Many pregnant women fear them, which explains the host of advice and products that claim to reduce your risk of getting them during pregnancy. Stretch marks are actually quite interesting, which is another way of admitting we don’t know much about them. We do know that if you are over 30 years old your chances of getting them are very low. Stretch marks typically occur in younger skin; for example, stretch marks that accompany a growth spurt are very common. The reason stretch marks are common to young skin and not so much with older skin has to do with the skin’s physical make up, which changes over time. Young skin is composed of a dermal layer full of tightly compacted skin cells supported by a matrix of criss-crossed, inter-connected protein fibers – this is called the extracellular matrix, or ECM. Think of it as a nice, new, firm mattress. It completely supports the outer covering or epidermis of the skin, the sheet, if you will, which stretches taut and smooth over the mattress. Now imagine you are trying to cover a mattress which is expanding to king size and beyond with your usual queen size sheet – the fibers will be undergoing stretching and pulling to accommodate the expansion. Fortunately skin can stretch and pull quite a bit because there is flexibility with respect to epidermal cell morphology – the skin cells elongate so that the sheet can expand without tearing. The stretch marks are visible evidence of this epidermal elongation and stretching. It’s a pretty amazing design, really, but when your skin returns to normal you may still bear evidence of stretch marks (which we are growing to accept more and more). The reason older skin does not (usually) have the same problem is a bit complicated, but it comes back to how skin changes as it ages. For one thing, the protein strands in the dermis aren’t as firm, as tightly compacted, or as numerous. So when the dermal mattress expands it does not do so in the same smooth manner; in fact it may even have sags or lumps in it (think wrinkles). This means there is not as much pressure on the epidermis to stretch – hence, no stretch marks. 

While there is also some evidence that suggests that stress hormones increase stretch mark vulnerability, from a purely mechanical perspective it’s not likely you’ll get stretch marks if your pregnancies are later on in life. Conditioning the skin and keeping it nourished and moisturized can always help, and also feels amazing, but we suggest avoiding investing in specialized products, as they often are not clean/safe for pregnancy, ineffective, and just generally not worth the expense.

Supporting Your Skin During Pregnancy and Postpartum

And finally, let’s talk about how you can best support your skin through all these changes, both topically and internally. 

The most important factor when it comes to topicals is to select products that are both safe *and* effective – for both yourself and your baby. Here we’ve compiled a list of our favorite skincare and supportive practices, including products, tips, and resources. There is never a perfect guidebook for anything, but we want to offer our support by giving you guidance on tools we trust, and you can bet we have done our research. Not surprisingly, we are obsessed with the microbiome, so all of our recommendations are supportive of maintaining healthy microflora in and on the body.

Product Recommendations for Topical Skin Support

Select well-formulated products that are deemed safe for pregnancy: choose products made fromhigh-quality, natural ingredients that also may include lab-grown ingredients that are bioidentical to those found in nature. (Ahem, this is Marie Veronique’s philosophy for product formulation, so no need to look any further!) Focus on ingredients that nourish the skin instead of stripping it, supporting barrier function, replenishing deficiencies, supporting microbial balance, and naturally reducing inflammation. Now is not the time to use active ingredients like acids/peels, retinoids, or skin bleaching agents, nor for at-home devices such as microcurrent, LED, or infrared. It’s good to be gentle and simple with your skin during this time, and facial massage during product application is a great way to be hands on with your skin.

• Avoid preservative-laden products and choose ingredients that are microstatic vs. bactericidal. We like horseradish extract, coconut fruit extract, aspen bark, Vitamin E, and Rosemary Oleoresin. We also recommend choosing products made in small batches so they don’t sit on your shelves for longer than necessary, and products that come in colored bottles, which serve to protect the product from degradation.
• Avoid synthetic fragrances.
• Limit the use of essential oils. Though they can have many benefits for the skin if they are good quality and used in proper concentrations, often they are improperly formulated and can induce photosensitization in the skin, creating vulnerability and potentially sensitizing the skin. Not to mention many are contradictory for pregnancy. 
• Choose zinc oxide-only sunscreens. This means no titanium dioxide or sensitizing chemicals such as Oxybenzone,Octinoxate, Homosalate, Octisalate, Octocrylene, or Avobenzone. 

Here are Marie Veronique’s suggested Pregnancy Skincare Products, which include the top three most important products we recommend for most people. (If you have questions, please email us for specific advice.)

• First trimester:  If seeing a rise in inflammation and breakouts, use Balancing HypoTonic + Soothing B3 Serum + Treatment Oil AM/PM.
• Second and third trimester: If skin is now feeling more balanced, use Vitamins C+E+Ferulic Serum + Barrier Restore Serum + Protective Day Oil AM/PM.
• Postpartum: If skin is feeling dry and/or depleted (symptomatic or not), use C-Therapy Serum + Barrier Restore Serum + Barrier Lipid Complex AM/PM.
• During any phase:
• For melasma: Soothing B3 Serum, C-Therapy Serum, Protective Day Oil
• As always, a full fat, plain yoghurt mask will offer wonderful benefits for all skin types. 
• For body skin, and especially a growing belly, we love organic sunflower seed oil massage with Mountain Rose Herbs Sunflower seed oil followed by Nucifera Balm.  

Suggestions for Supporting Your Internal Systems

In regards to skin function, we focus a lot of attention on the internal systems. Supporting the body during pregnancy and postpartum is so important, and while it can be very individual to everyone, we have found that holistic and comprehensive support of microbial balance, immune function, nervous system and blood system, and circulation is crucial for skin health, especially during pregnancy and postpartum. 

Here’s a brief overview of how to support your internal body during pregnancy and postpartum, along with some additional resources for more information. As always, find practitioners and support systems that you trust and can guide you in the right direction. 

1. Nourishment. Focus on whole, real foods: protein, healthy fats, fiber, fermented foods. Worry less about dietary restrictions and instead boost caloric and nutrient density. Current research suggests that the fetus may have less risk of food allergies if the mother consumes small amounts of all food types throughout her pregnancy. Additionally, consider takinga high-quality, tested, daily prenatal (inclusive of iron, methylated B vitamins, choline, selenium, iodine, and Vitamin D). We also recommend supplementing Omega 3, probiotics, and magnesium, as needed. Eat organic, whenever possible, limit packaged/processed foods, and avoid plastic as much as possible – it’s very important to reduce exposure to pesticides, food system antibiotics, parabens/phthalates, and other environmental toxins.
2. Hydration. Challenging but key! Aim for three liters of water each day. If you can, add lemon or try sparkling water on occasion (but keep mostly to still). 
3. Support your gut microbiome. Eat a wide variety of whole foods, with adequate fiber and varied flavors (bitter, sour, salty, savory, aromatic spice, heat [if tolerated], etc.). Limit sugar and sweets, along with packaged and processed foods. Current research and microbiome studies are looking closely at how incubation periods for mother and child can influence a child’s microbiome and therefore impact development and overall health. From our perspective, and because skin function is so closely linked to microbial function, it’s important to really consider ways to support a healthy microbiome for yourself and your growing baby.
4. Oral hygiene. Due to the increase of inflammation in the mucous membranes of the body, oral hygiene is incredibly important (also, current research reveals that oral microbiota can cross the placenta and reach the fetus!). Try to see your dentist at least once (ideally once per trimester) while pregnant, and be sure to floss daily. Rinse the mouth with warm salt water (gargle if you can), and choose a safe and microbiome-friendly toothpaste (we like Revitin). If you have a lot of swelling and bleeding gums, it is ok to use a soft brush and be extra gentle (also, don’t panic, this is totally normal, just more reason to support during this time!). 
5. Healthy daily habits. As always, make time for self-care: exercise and movement, restorative practices such as yoga, stretching, breathing techniques, mindfulness, healthy sleep habits (being aware that sleep will change throughout pregnancy and postpartum), connection with your support community, and healthy stress management. All have a big impact on your changing physical and emotional state and therefore deeply benefit skin function. 

For additional reading and support, here are a few resources and communities we absolutely love: Spinning Babies, Yoga Medicine , Erica Chidi & Loom HQ, Aviva Romm, Emily Oster, and Akin.

Summing Up

Pregnancy, and pregnancy skin, is such a unique life experience. Amidst a surge of so many changes, the skin and the body adapt and evolve, and if we are supportive, we have the ability to create positive and meaningful changes. Sometimes support means doing less, and that’s actually something we strive for in skin care. When you are strategic (rather than reactive) with your products, support, and rest, you will have achieved what you set out to do in the first place – set your baby (and yourself) up for the best care possible.  

Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.

*Photo credit: Terri Lowenthal for our friends at Woom Midwifery, who have created a beautiful organization to support women through this process.

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