Pregnancy ushers in a whirlwind of changes within a woman’s body, with the skin often bearing the brunt of the transformation.
While the pregnancy glow is often celebrated, the reality for many women is more complex. Hormonal shifts during pregnancy can lead to a variety of skin changes, ranging from acne and pigmentation to heightened sensitivity.
These changes, while natural, can have significant emotional and psychological impacts, influencing how women feel about themselves during a time when their bodies are already undergoing profound transformation.
This was a reality for Farah Faizal, a 28-year-old marketing manager, who recently took to X (formerly Twitter) to share her struggles with facial skin issues during pregnancy. Her post, detailing bouts of acne and dark patches that left her feeling self-conscious, resonated widely, garnering millions of views and having conversation about the less-discussed side of the so-called pregnancy glow.
Explaining the issue, Prince Court Medical Centre Consultant Obstetrician and Gynecologist and Fertility Specialist Dr Maiza Tusimin noted that such changes are rooted in the hormonal shifts that occur during pregnancy
"Pregnancy triggers a cascade of hormonal changes, directly influencing the skin's behavior. Rising levels of estrogen, progesterone and human chorionic gonadotropin (hCG) lead to increased oil production, pigment changes and heightened skin sensitivity," she said to Sinar Daily.
According to her, acne flares are common as overactive sebaceous glands produce excess oil.
Simultaneously, pigmentation issues such as melasma—characterised by dark patches on the face—result from hormone-induced stimulation of melanin-producing cells.
A 2014 study published in the International Journal of Dermatology found that up to 90 per cent of pregnant women experience skin changes, with melasma affecting 15 to 50 per cent, depending on genetic and ethnic backgrounds.
When do skin changes occur?
Dr Maiza highlights that these changes often peak during the second and third trimesters when hormonal levels are at their highest.
"Melasma typically appears in the second trimester, while acne may occur earlier, even in the first trimester, as oil production increases," she said.
She also said certain factors can heighten susceptibility to these changes. Younger mothers, women with darker skin tones (Fitzpatrick types IV–VI) and those frequently exposed to sunlight are more at risk.
"While these changes can occur in any pregnancy, they are not necessarily more pronounced in first pregnancies," she added.
Commenting further, Dr Maiza said hormones play a pivotal role in the skin changes that occur during pregnancy, with estrogen, progesterone and other hormonal shifts acting as key drivers.
She explains that estrogen stimulates melanocyte activity, which increases melanin production and leads to pigmentation changes, such as melasma.
Progesterone, another dominant hormone during this time, contributes to overactive sebaceous glands, resulting in increased sebum production and, consequently, acne outbreaks.
Additionally, hormonal changes influence the vascular system, causing visible effects such as spider angiomas—small, red, spider-like blood vessels that appear near the skin’s surface—and palmar erythema, which manifests as reddening of the palms.
These vascular changes are generally harmless but can be surprising for first-time mothers.
"These hormonal shifts are a natural part of pregnancy as the body adapts to support the growing baby. While they may be distressing, they are generally temporary and resolve after delivery," she said.
Moreover, the expert said immunologic shifts during pregnancy may exacerbate or alleviate pre-existing skin conditions like eczema or psoriasis.
For many women, these skin changes are more than cosmetic.
"Visible acne or pigmentation can significantly affect self-image and confidence, especially in cultures where clear skin is tied to beauty standards," she noted.
Postpartum resolution and treatment
The good news is that most pregnancy-related skin changes resolve after delivery as hormone levels normalise.
"While many women notice improvements within weeks, others may take months or longer," she said.
For persistent pigment changes, treatments like topical vitamin C, azelaic acid or laser therapies may be recommended postpartum, once breastfeeding considerations are addressed.
According to Dr Maiza, a 2018 review in Dermatologic Clinics reported that 60 to 70 per cent of women experience spontaneous resolution of melasma within a year of delivery.
Dr Maiza shares her top recommendations for expectant mothers:
- Simple skincare: Stick to fragrance-free, non-comedogenic products and avoid harsh exfoliants.
- Safe ingredients: Use pregnancy-safe actives like azelaic acid under medical guidance. Avoid retinoids, hydroquinone, and high-strength salicylic acid.
- Sun protection: Use a mineral sunscreen with zinc oxide or titanium dioxide to prevent melasma from worsening.
- Healthy lifestyle: Stay hydrated, consume antioxidant-rich foods, and prioritise sleep.
- Professional guidance: Consult a dermatologist early for distressing skin changes and validate concerns about appearance.
Dr Maiza emphasises that pregnancy brings natural and temporary skin changes, but that doesn’t mean women have to suffer in silence.
"With the right approach, these challenges can be managed effectively without compromising maternal or fetal health," she said.
By combining evidence-based care with emotional support, expectant mothers can navigate these changes confidently, preserving their well-being and self-esteem throughout the transformative journey of pregnancy.