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Study: with retinoids, contraceptives should be given to protect the fetus
Last reviewed: 02.07.2025
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Prescription oral retinoids are growing in popularity for acne treatment. Unfortunately, data shows that not enough precautions are being taken to protect women from the risk of serious birth defects if they become pregnant while taking the medication.
Demand for oral retinoids to treat acne has nearly doubled in the past nine years, but a study has found that contraception is not being given due consideration for women of reproductive age taking the drugs.
Oral retinoids such as isotretinoin, when taken during pregnancy, can cause miscarriages, serious birth defects, and problems with neurodevelopment in the baby. These serious problems are not seen with retinoids applied to the skin.
Researchers are concerned about the increasing use of retinoids and the lack of contraceptive coverage, with only 1 in 4 women taking both drugs.
"Every woman should have an effective contraceptive plan in place well before starting oral retinoids. Only then can we reduce the number of unintended pregnancies among women taking oral retinoids and therefore reduce the risk of harm to unborn babies," said senior author Dr Antonia Shand, from the University of Sydney.
"It's definitely a problem. I've seen a lot of women who got pregnant while taking oral retinoids and then had to deal with the aftermath," said lead author and maternal-fetal medicine specialist Dr. Laura Gerhardy.
The findings, published in the Australasian Journal of Dermatology, examined data from Australia's Pharmaceutical Benefit Scheme between 2013 and 2021 for a sample of Australian women aged 15 to 44 years.
Researchers from the University of Sydney and the University of New South Wales analysed the frequency of prescriptions for oral retinoids and how many were accompanied by contraception.
Over nine years, 1,545,800 prescriptions for retinoids were written for women of reproductive age, and 57% of these were for oral retinoids in Australia. The rest were for topical retinoids.
The rate of prescriptions for oral retinoids has doubled from 1 in 71 women in 2013 to 1 in 35 women in 2021. However, only 25% of these oral retinoid prescriptions in 2021 were accompanied by evidence of contraceptive use.
Leading dermatology, obstetrics, and pharmaceutical regulatory bodies recommend avoiding pregnancy while using oral retinoids and for some period after treatment.
However, Australia currently has no standardized pregnancy prevention program for women taking oral retinoids. By comparison, the United States requires women to take two types of contraception when using oral retinoids.
The researchers call for better education for doctors and a clear path for women of reproductive age to safely obtain both retinoids and long-term reversible contraception.
They also stress the importance of education for women. This includes developing an effective contraceptive plan well before a prescription for oral retinoids is issued to prevent possible harmful effects in the future.