Episode 34 - Topical retinoid use and risk of congenital malformations

In this episode of BJD Talks, Sam and Meera discuss the article ‘Topical retinoid use in women of reproductive age and risk of major congenital malformations in exposed pregnancies: a Nordic cohort study’ by Refsum et al. The full article can be accessed at https://doi.org/10.1093/bjd/ljaf500 

*This podcast was generated by an AI tool created by 67Bricks for the British Association of Dermatologists* 

Transcript

SPEAKER_00 0:00

Welcome to BJD Talks, the official podcast of the BJD. I'm Sam.

SPEAKER_01 0:04

And I'm Mira. In this episode, we'll be discussing the article by Earl Refsum et al. Topical Retinoid Use in Women of Reproductive Age and Risk of Major Congenital Malformations in Exposed Pregnancies, a Nordic cohort study from December 2025 and included in the April 2026 issue.

SPEAKER_00 0:24

This study really caught my eye. Between 2006 and 2024, topical retinoid use among women aged 15 to 44 in Denmark, Iceland, Norway and Sweden tripled from 8.7 per 1000 to 28.5 per 1000. Quite the leap.

SPEAKER_01 0:43

Topical retinoids are commonly used to treat acne, but their safety in pregnancy has been unclear. The study set out to examine whether topical retinoid use in pregnancy is linked to an increased risk of major congenital malformations, or MCMs.

SPEAKER_00 1:00

And what a rigorous study it was, spanning more than 3.8 million pregnancies from four Nordic countries. Using linked data from prescriptions and hospital records, they estimated first trimester exposure to topical retinoids and associated risks of MCMs.

SPEAKER_01 1:16

To break it down, they analyzed 3.8 million pregnancies carried to at least 22 weeks. Of these, 0.86 per 1000 were exposed to topical retinoids in the first trimester. MCMs were observed in 3.3% of exposed pregnancies, compared to 3% in unexposed pregnancies, and 2.6% in pregnancies exposed to alternatives like azoleic acid.

SPEAKER_00 1:43

What's striking is that after adjusting for factors like maternal age and birth year, the adjusted risk ratio was 1.1, with confidence intervals crossing 1. No statistically significant increase in MCM risk was found, which seems to somewhat allay fears around topical retinoid use.

SPEAKER_01 2:00

While reassuring, we must interpret this cautiously. The study excluded pregnancies ending before 22 weeks. This means early miscarriages or terminations due to anomalies weren't captured, which could underestimate exposure rates and risks.

SPEAKER_00 2:16

Good point. Exposure misclassification is another factor. Filling a prescription doesn't guarantee the medication was used, particularly during pregnancy, unless potent over-the-counterproducts containing retinoids weren't included either.

SPEAKER_01 2:30

Yet the study addressed whether topical retinoids could replicate the teratogenic effects of systemic isotritinoin, like cardiac malformations or fetal retinoid syndrome. Their data showed no consistent pattern of such anomalies.

SPEAKER_00 2:48

The authors suggest their findings offer reassurance for women who may inadvertently use topical retinoids, though caution remains necessary. What's your view?

SPEAKER_01 2:57

I think the key takeaway is reassurance, delivered with care. This study adds valuable data, but doesn't warrant a complete shift in guidelines just yet. More comprehensive data, including all pregnancy outcomes, are still needed.

SPEAKER_00 3:13

Absolutely. For dermatologists, this underscores the importance of patient education. Women of reproductive age using topical retinoids should be informed about risks, even if current evidence suggests those risks may be lower than initially feared.

SPEAKER_01 3:27

A balanced approach is best. Avoid topical retinoids in planned pregnancies as a precaution, but know that incidental exposure doesn't appear to pose significant harm based on available data.

SPEAKER_00 3:39

Well put, Mira. That wraps up this episode. Thanks for listening to BJD Talks. And do read the full article by Earl Refsermetal for more insights. Until next time.