Is it safe to get Botox when you're pregnant? Here's what experts say.

Maybe you’ve been getting Botox to smooth out fine lines for years. Or perhaps you haven’t found anything quite as effective to treat chronic migraine or some other non-cosmetic health concern. But now you’re having a baby, and you’re wondering: Are these injections safe during pregnancy? Here’s what experts say.

Why research is limited

According to Dr. Kumara Sundar, a family medicine physician with Kaiser Permanente who specializes in women’s health and maternity services, there is limited research on Botox use during pregnancy, as it would be “unethical to design a study” that could potentially put pregnant women at risk. As such, “it is unclear exactly what the risks might be to the unborn child,” he tells Yahoo Life.

But there are some published reports about Botox use in pregnancy, though Sundar cautions that they are not definitive. One 2006 survey study of physicians published in the Journal of Neurology, Neurosurgery and Psychiatry — in which just 12 reported injecting a pregnant woman with Botox — concluded that Botox “appears to be relatively safe for both expectant mother and fetus” when administered during pregnancy. But because a survey differs from a clinical trial — in which treatment is administered under tightly controlled conditions and participants are closely monitored — cosmetic dermatologist Dr. Michele Green warns that such results “can be biased, as individuals are more likely to respond with good outcomes.”

There have been some studies involving Botox use in pregnant rabbits and mice, with mixed results, a 2013 article published in Canadian Family Physician noted. “However, animal studies do not always translate to humans,” Green adds.

Because of the lack of research on Botox use during pregnancy, the FDA has classified it as a category C drug, “meaning there is little research to determine if it is safe during pregnancy,” Green explains. Until more data is available, Sundar advises expectant mothers to carefully consider the “benefits and potential risks” with their health care provider.

What are the risks?

Pregnant or not, anyone who uses Botox should be aware of any potential health complications. Sundar notes that these are typically minimal and may include bruising, headache or a temporarily drooping eyelid.

But because Botox contains botulinum toxin, there is a risk of contracting botulism. “The theoretical risk would be developing systemic botulism beyond its localized intended location,” explains Dr. Leah Ansell, a dermatologist at Treiber Dermatology Associates. “This could cause widespread muscle and breathing paralysis.”

The 2006 survey study cited above notes that there have been multiple cases of pregnant women developing botulism unrelated to Botox use; though two cases involved premature delivery, the majority saw no significant impact on pregnancy or evidence of infantile botulism.

What about using Botox for medical reasons?

Some people use Botox for a range of medical conditions, including chronic migraine, eye muscle disorders and muscle stiffness, according to Sundar. While doctors “generally advise against elective procedures during pregnancy,” including cosmetic procedures, the risk-benefit analysis might be different if a pregnant woman needs Botox for medical reasons, Ansell says.

If a woman does need Botox for medical reasons, the “benefits and potential risks to both the mother and the infant should be considered,” Sundar adds.

Can you get Botox while trying to conceive?

Trying for a baby? You might want to get your quarterly touch-up before getting down to business. According to Green,“it is recommended to stop getting Botox injections immediately before trying to conceive to minimize any risk to a future pregnancy.”

As a cosmetic dermatologist, Green does not routinely test women for pregnancy before administering Botox. Instead, providers “generally rely on the patient to inform them if they are pregnant or trying to conceive,” she says. Ansell says that she has “turned away patients who come in for Botox but are in the ‘two-week window’ where they may or may not be pregnant.” It’s also recommended that patients who think they could be pregnant take a test before an appointment to get Botox, out of an abundance of caution.

But what if you find out you’re pregnant after a recent Botox appointment? If you inadvertently get Botox while pregnant, “mention it to your ob-gyn but do not panic,” says Dr. Victoria Scott, a urogynecologist at Cedars-Sinai.

According to Sundar, “on average, Botox lasts three to four months,” so some women will conceive with Botox still in their systems. Other women will receive injections early in pregnancy before they know that they are pregnant.

There probably isn’t any reason to worry if this happens to you. “With proper administration of Botox, it is not expected to enter systemic circulation and stays at the local site where it is injected,” he explains. Additionally, Botox “does not appear to cross the placenta in pregnant women who have had Botox administered,” Sundar adds.

When can you get Botox again?

Having a baby doesn’t mean giving up Botox forever, but moms shouldn’t expect to rush back to the dermatologist after giving birth. “You can get Botox injections once you are no longer pregnant or you have stopped breastfeeding,” Green says.

Again, there’s a lack of data to go on. “Botox is not detectable in the bloodstream after intramuscular injection so it is highly unlikely to get in breast milk in any significant amount,” explains Cedars-Sinai urogynecologist Dr. Karyn Eilber, who, like Scott, is a co-author of A Woman’s Guide to Her Pelvic Floor: What the F*@# Is Going On Down There? But given the absence of evidence, many experts prefer to err on the side of caution. “It is not safe to get Botox while breastfeeding, as there is little to no research to determine its effects,” Green says.

If a new mom is not planning to breastfeed, however, Sundar says it’s safe to resume Botox injections “as soon as they feel comfortable.”

The takeaway

Sundar notes that while “Botox is not expected to cause fetal harm,” the lack of definitive studies regarding pregnancy and lactation means a conservative approach is best, particularly if the injectables are for cosmetic purposes only. “The risk alone is enough to avoid Botox when not medically necessary,” he says. And when it is medically necessary, a doctor should be consulted first.

“The best action is to be cautious and avoid unnecessary risks that may harm you or your child,” adds Green.