Is topical Vitamin A really dangerous during pregnancy?
by Dr Des Fernandes
Many people worry about the safety of using Vitamin A creams during pregnancy and lactation. In fact, some medical professionals even advise against it. I would like to dispel some of the myths and present some of the facts associated with how Vitamin A behaves in the skin, in order to create some understanding of what is actually a very necessary and efficacious molecule for the development of normal cells.
Vitamin A does not cross from your skin into your bloodstream
How do we know this?
Studies have been done testing radio-labelled retinoic acid and the first time this study was done in the 1980’s they could not detect any retinoic acid in the bloodstream. The test was repeated with far more sensitive instruments in the later 90’s and a minute number of labelled molecules were detected. We know that Vitamin A is trapped in the skin. Our bodies have evolved to do this for many reasons – some to do with protection from the sun. Other tissues in the body can absorb Vitamin A from the bloodstream and then get back into it because they have the enzymes to do that, but skin does not have those same enzymes. The liver is an example of an organ that can transport Vitamin A to other tissue by linking retinol to serum proteins – the skin is not.In the skin we do not have the enzyme process to link retinol to serum proteins like those in blood. Vitamin A is easily accepted in the skin. Under physiological conditions it is taken up by cell wall retinoid receptors and transported into the cell where it is stored as retinyl esters (usually retinyl palmitate). The retinyl palmitate is metabolised through retinol to retinaldehyde and then, close to the nucleus, it is further oxidised to become retinoic acid. There are receptors for retinoic acid in the nucleus of the skin cell where the DNA resides. Virtually all the effects of Vitamin A are produced through DNA interaction.
Why do we say that Vitamin A creams should not be used in the first trimester then?
This is because women may experience foetal abnormalities from some other cause and, because they have been using Vitamin A creams, wrongly accuse them of being the culprit. There is a lot of misinformation out there and we do not want to fall victim to it, even innocently.
Why should we use Vitamin A creams during pregnancy?
I believe Vitamin A helps to reduce the chance of developing stretch marks, but I admit that if the mother does not get stretch marks, we have to accept that she might not have developed them in any case!
The nutritional demands on your body increase during pregnancy and lactation, leaving your skin with even less available Vitamin A than usual. If you believe, as I do, that Vitamin A is essential for beautiful healthy skin, then you will realise that you need your Vitamin A creams more than ever.
Other things to think about regarding safety of Vitamin A creams in pregnancy and after
The concentration of Vitamin A in creams (even the very strongest ones) is far too low to be of any concern for foetal abnormalities. One has to realise that only a maximum of 6% of topically applied vitamin A will get to the stratum basal and papillary dermis anyway. The vitamin A is then in the ester form generally, and so it gets accepted by the cellular receptors and enters into the skin cell, not the blood.
If we turn this problem on its head and consider the dangers of not having sufficient quantities of Vitamin A during pregnancy, a very different picture emerges. Foetal abnormalities are far more likely for mothers with diets low in Vitamin A.
Next, during lactation, many people use Vitamin A creams (usually the low dose products) to treat cracked nipples while breast-feeding. I believe that the baby gets a minute dose of Vitamin A, which is not a bad thing seeing that Vitamin A deficiency holds such a fatal risk and is also so common around the world.
A study in Japan showed that, in this first-world country that eats a lot of vitamin A-rich fish, the general population was probably at about 80% of ideal levels of vitamin A, and this deficiency is made worse for women in pregnancy because Japanese women are usually told to avoid Vitamin A during pregnancy. Most likely, women are rather under-nourished in vitamin A because the placenta steals as much Vitamin A as it can from the mother to give to the baby! We know (and the placenta clearly knows too) that Vitamin A is necessary when cells are dividing and replicating at such a rapid pace as in gestation.
Like any substance on earth, the poison is not in the substance itself, but in the dose. Even the most seemingly benign chemicals like water and oxygen, can, under the right circumstances and at the right dose, be killers. And even the most seemingly toxic can be healers!
I believe topical vitamin A is safe because it has a very low penetration and then is not transported into the blood stream.