Can You Get Botox When Pregnant? Risks & Safe Alternatives

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Botox is a cosmetic treatment that helps reduce the appearance of wrinkles on the face. Several women undergo this procedure, but is it safe to get a botox while pregnant?

Botox (a brand name for onabotulinumtoxinA) is a drug made from the same toxin that causes botulism, a life-threatening food poisoning condition. However, since the toxin is used in low doses for cosmetic and medical purposes, it is unlikely to cause toxicity. Nevertheless, its safe use in pregnancy requires guidance.

Read on to know more about the safety and risks of using botox during pregnancy (1).

What Is Botox?

Botox is another name for onabotulinumtoxinA, a form of Botulinum toxin, which is a neurotoxic protein produced by Clostridium botulinum and related species of bacteria. It acts by blocking the release of the neurotransmitter acetylcholine from nerve endings, reducing muscle activity.

The use of Botox is approved by the US Food and Drug Administration (FDA) for the following cosmetic and medical purposes (2).

  • Temporary smoothening of wrinkles such as frown lines between the eyebrows and crow’s feet around the side of the eyes
  • Urinary incontinence (unintentional passing of urine) due to detrusor muscle overactivity
  • Severe underarm sweating
  • Chronic migraine
  • Cervical dystonia (involuntary contractions of the neck muscles)
  • Blepharospasm (uncontrolled blinking or eyelid twitching)
  • Strabismus (abnormal eye alignment)

Is Botox Safe During Pregnancy?

The FDA classifies Botox under pregnancy category C, which means that animal studies have shown adverse effects in the fetus, but well-controlled studies in humans are inadequate. FDA further also advises the following.

  • Botox is to be used during pregnancy only if its potential benefits to the mother justify the potential risks to the fetus (2).
  • Botox’s cosmetic use is to be avoided during pregnancy and breastfeeding (3).

Available scientific evidence states the following.

  • Botox injected in muscle or under the skin, in recommended doses, does not attain toxic concentrations in blood.
  • Its molecular size is not small enough to cross the placenta and reach the fetus.
  • Toxicities shown in animal studies were at much higher doses than those used in humans.
  • Case studies on the medical use of Botox in pregnant women mostly report no abnormal pregnancy outcomes (4).
  • A 24-year review showed that the risk of abnormal birth outcomes in women exposed to onabotulinumtoxinA before or during pregnancy is not more than what is expected in the general population (5).

OnabotulinumtoxinA is often considered an option to prevent episodes of chronic migraine during pregnancy over some drugs, which may have fetal toxicities (6). Nevertheless, you must use Botox after doctor consultation and prefer it only when the benefits outweigh the risks.

What Are The Risks Of Using Botox When Pregnant?

There are no specific maternal or fetal toxicities identified due to Botox use. However, it may cause side effects, which may be more troublesome during pregnancy.

1. Muscle problems

Problems with breathing or swallowing may occur since muscles used for these purposes may weaken after a Botox injection. People with existing breathing problems may have a higher risk of side effects. Swallowing problems may last for months.

2. Spread of toxin

The toxin may spread from the injection site and cause botulism. It could lead to the following symptoms.

  • Loss of strength and generalized muscle weakness
  • Blurred or double vision
  • Drooping eyelids
  • Trouble speaking clearly, hoarseness, or change of voice
  • Breathing and swallowing difficulties

These symptoms may take anywhere from hours to weeks to develop after a Botox injection. Inform your doctor immediately if you have any of these symptoms (7).

What Are The Safe Alternatives To Botox For Cosmetic Purposes During Pregnancy?

You may consider Botox alternatives, which may not be as effective as Botox, but pose minimal to no risk to your pregnancy.

  • Chemical peels such as glycolic acid peels and lactic acid peels are considered safe skin treatments during pregnancy due to negligible dermal penetration (does not reach beyond skin layers). However, safety data is insufficient, and you should consult with your doctor first (4).
  • Argireline (topical), a synthetic anti-wrinkle polypeptide, may be used under medical supervision (8).
  • Some over-the-counter moisturizers or products containing hyaluronic acid may be helpful, and you may use them after consulting a dermatologist (9).

How Soon After Giving Birth Can I Get Botox?

There is no guideline to help you decide the correct time after childbirth to get Botox. It is often advised to start or resume Botox injections after you have stopped breastfeeding your child. The FDA says that it is not clearly known whether Botox passes into breast milk. Botox injections for cosmetic use are usually not recommended during pregnancy or breastfeeding (10). Talk to your doctor or your child’s pediatrician for medical advice. You may read more about the safety of Botox during breastfeeding here.

Frequently Asked Questions

1. Does Botox cause birth defects?

Exposure to Botulinum toxin during pregnancy has not shown to cause birth defects. However, it cannot be confirmed due to a lack of research, and hence doctor’s advice is necessary before proceeding with botox during pregnancy (11).

2. Can Botox cause miscarriage?

Although botox during pregnancy is not known to increase the chances of miscarriages, more research is needed to confirm it (12).

Botox or onabotulinumtoxinA may have no added risk during pregnancy, but current studies are insufficient to confirm its safety. It is best to avoid Botox for cosmetic purposes during pregnancy and breastfeeding. However, it may be used for medical purposes where the benefits to the mother outweigh the risks to the fetus. Before opting for a Botox treatment, tell your doctor about all medications you are taking to prevent any drug interaction.

Key Pointers

  • The US Food and Drug Administration (FDA) usually advises botox for urinary incontinence, migraines, and reducing wrinkles in certain cases.
  • Botox injection during pregnancy may cause botulism and muscle problems.
  • Since the studies on botox are limited, it is advisable to use safer alternatives to reduce wrinkles, such as glycolic peels and moisturizers.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
  1. Botox.
    https://medlineplus.gov/botox.html
  2. Botox.
    https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5232lbl.pdf
  3. Botox injections.
    https://www.nhs.uk/conditions/cosmetic-procedures/botox-injections/
  4. M.K. Trivedi et al.; (2017); A review of the safety of cosmetic procedures during pregnancy and lactation.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418954/
  5. Mitchell F. Brin et al.; (2016); Pregnancy outcomes following exposure to onabotulinumtoxinA.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063122/
  6. Ho-Tin Wong et al.; (2020); OnabotulinumtoxinA for chronic migraine during pregnancy: a real world experience on 45 patients.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599093/
  7. Medication Guide BOTOX® BOTOX® Cosmetic.
    https://www.fda.gov/media/77359/download
  8. Argireline in Treatment of Periorbital Wrinkles.
    https://clinicaltrials.gov/ct2/show/NCT01381484
  9. Eleni Papakonstantinou et al.; (2012); Hyaluronic acid: A key molecule in skin aging.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583886/
  10. Rebecca Small; (2014); Botulinum Toxin Injection for Facial Wrinkles.
    https://www.aafp.org/afp/2014/0801/p168.html
  11. Botulinum toxin.
    https://www.medicinesinpregnancy.org/Medicine–pregnancy/Botulinum-toxin/
  12. OnabotulinumtoxinA (Botox®).
    https://mothertobaby.org/fact-sheets/onabotulinumtoxina/
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Dr. Joyani Das

Dr. Joyani Das did her post-graduation from Birla Institute of Technology, Mesra and PhD in Pharmacology. Previously, she worked as an associate professor, faculty of Pharmacology, for two years. With her research background in preclinical studies and a zeal for scientific writing, she joined MomJunction as a health writer. Her research work was published in international journals and publications, such... more

Dr. Karla S. Sanchez-Banos

(MD)
Dr. Karla S. Sanchez-Banos is a board-licensed Ob/Gyn in Mexico, specializing in Adolescent Gynecology. She is also trained in Gynecological Endocrinology, granted by AMEGIN (Gynecological Endocrinology Mexican Association). Her decade-old experience includes scientific research in teen pregnancy and the use of long-acting reversible contraceptive methods in the adolescent age group.  Dr. Karla currently works in two private medical centers in... more

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