Risks of Oral Isotretinoin During Early Pregnancy: What You Need to Know

Oral isotretinoin causes teratogenicity?

Hello doctor, my last menstrual period was on September 1st.
Recently, my skin condition has been very poor, so I went to see a dermatologist.
At that time, I was not pregnant, so the doctor prescribed me oral isotretinoin.
I took five pills from September 25th to 29th, but I am worried about the possibility of being pregnant, so I didn't dare to continue taking it.
However, my period has still not arrived, and this morning I took a pregnancy test which showed two lines.
If I was taking isotretinoin before realizing I was pregnant, could it cause birth defects? Would you recommend terminating the pregnancy?

Gao Xiaowa, 20~29 year old female. Ask Date: 2018/10/04

Dr. Huang Jianzhong reply Obstetrics and Gynecology

My last menstrual period was on September 1.
Recently, my skin condition has been very poor, so I visited a dermatologist.
At that time, I was not pregnant, so the doctor prescribed oral isotretinoin.
I took five pills from September 25 to 29, but I was afraid of possibly being pregnant, so I didn't dare to continue taking it.
However, my period has not come yet, and I took a pregnancy test this morning which showed two lines.
If I was on oral isotretinoin before realizing I was pregnant, could it cause birth defects? Answer: No, it does not cause birth defects.
Should I consider terminating the pregnancy? Answer: Termination of the pregnancy is not recommended.

Reply Date: 2018/10/04

More Info

Oral isotretinoin, commonly known as Accutane, is a powerful medication primarily used to treat severe acne. However, its use during pregnancy poses significant risks to fetal development, leading to severe birth defects and other complications. The medication is classified as a Category X drug by the FDA, indicating that it is contraindicated in pregnancy due to evidence of fetal harm.

The risks associated with isotretinoin during early pregnancy are substantial. Studies have shown that exposure to isotretinoin during the first trimester can lead to a range of congenital malformations, including craniofacial abnormalities (such as cleft lip and palate), cardiac defects, and central nervous system anomalies. The teratogenic effects of isotretinoin are well-documented, and it is estimated that approximately 25-35% of infants exposed to the drug during the first trimester may be affected by serious birth defects.

In your case, since you took isotretinoin between September 25 and 29 and have now confirmed a pregnancy, it is crucial to consult with your healthcare provider immediately. The timing of your medication intake relative to your menstrual cycle suggests that you may have been pregnant during that period, even if you were unaware at the time. The potential for teratogenic effects means that you should not make any decisions regarding your pregnancy without professional guidance.

It is essential to have a thorough discussion with your obstetrician or a maternal-fetal medicine specialist about the risks involved. They may recommend additional monitoring and imaging studies to assess the health of the fetus and identify any potential abnormalities. In some cases, a referral to a genetic counselor may be beneficial to discuss the implications of isotretinoin exposure and to explore your options moving forward.

Regarding the question of whether to terminate the pregnancy, this is a deeply personal decision that should be made after careful consideration and discussion with your healthcare team. They can provide you with the necessary information about the risks and potential outcomes, allowing you to make an informed choice that aligns with your values and circumstances.

In summary, the use of oral isotretinoin during early pregnancy carries significant risks for fetal development. Immediate consultation with a healthcare provider is essential to assess the situation and determine the best course of action. Remember, you are not alone in this; many women have faced similar situations, and healthcare professionals are equipped to support you through this challenging time.

Similar Q&A

Concerns About Oral Accutane Use During Early Pregnancy

Hello, Doctor. I would like to ask about the issue of pregnancy and oral isotretinoin. My last menstrual period started on August 7, and I believe my husband and I did not have sexual intercourse during that time. It is more likely that we had intercourse between August 26 and Se...

Dr. Huang Jianzhong reply Obstetrics and Gynecology
The last menstrual period started on August 7, and my husband and I believe that we likely had sexual intercourse between August 26 and September 8. I took a pregnancy test on September 22 and found out I was pregnant. However, I suddenly recalled that during the period from Sept...

Should You Continue a Pregnancy After Taking Oral Accutane?

Hello, doctor. Today, on June 18, I found out that I am 2 weeks pregnant (my last menstrual period was on May 2). However, I had been taking oral isotretinoin for two months, which I stopped at the end of April. Since oral isotretinoin has the potential side effect of causing fet...

Dr. Lin Xinwang reply Obstetrics and Gynecology
Hello: Oral isotretinoin has teratogenic effects, and it is generally recommended to stop the medication three months before attempting to conceive. A high-level ultrasound is typically advised between 20 to 24 weeks of gestation. As of June 18, the gestational age should be arou...

Does Using Tretinoin Cream One Month Before Pregnancy Affect You?

Using topical retinoids, such as tretinoin (commonly referred to as A acid), one month prior to pregnancy may have potential risks. However, the effects can vary based on the amount used and individual circumstances. It is advisable to consult with a healthcare provider for perso...

Dr. Zhang Kunmin reply Obstetrics and Gynecology
Hello, the use of medications containing retinoic acid (commonly referred to as vitamin A acid) is generally contraindicated during pregnancy, as they are classified as Category X, indicating they are unsafe. If you discover that you have been using such medications prior to preg...

Understanding the Risks of Accutane: Concerns About Birth Defects

Hello, doctor. Last year, I had acne, and my doctor recommended that I take vitamin A acid. I have already stopped using it, but it seems that this medication carries a risk of teratogenicity. I heard that if the retinoic acid is not completely metabolized in the body, it could l...

Dr. Lin Mingxing reply Family Medicine
The obstetrician-gynecologist has responded.