Acne and pregnancy: what to do?

Treatments used for acne patients who are pregnant may have potentially harmful effects on the mother or fetus. Likewise, physicians should be aware that not every pregnancy in the absence of drug therapy results in the delivery of a perfectly healthy baby. Indeed, birth defects are known to occur in 2-3% of all newborns. Physicians prescribing a drug for women of childbearing potential should have several concerns. First, before conception some medications have been associated with a possible risk of contraceptive failure. Rifampin has been reported to reduce the effectiveness of oral contraception, while controversies exist regard the effect on estroprogestinic contraception of systemic antibacterial agents used for acne, such as tetracyclines. During very early pregnancy (first 2 weeks) cells are undifferentiated; as a consequence, drugs administered during this phase of pregnancy affect all cells equally and may lead to spontaneous abortion. Organogenesis lasts from 2 to 8 weeks of gestation. At this stage, differentiating cells may be affect by particular drugs and result in congenital anomalies (teratogenesis). In midpregnancy (second trimester) fetal development may be affected by maternal drug use as maturation of various organ system occurs. For example, tetracyclines are known to produce tooth discoloration when taken after he fourth month of pregnancy. Late in pregnancy, especially near time of delivery, non-teratogenic conditions may occur. Several rating systems are available to assist physicians in determining the relative safety of dermatologic drugs to the fetus. The most used sources of information about drug toxicity are the Food and Drug Association (FDA) Pregnancy Categories and the Teratogen Information Service (TERIS). FDA increasing pregnancy risk categories are ranked as A, B, C, D, X and Undetermined. TERIS risks are rated None, Unlikely, Minimal, Moderate, High and Undetermined. In the following table the main molecules used for treating acne are reported, with FDA pregnancy category and TERIS risk rating.