Pregnancy and Accutane

Acne in pregnancy
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Accutane is a medication that was used to treat severe acne. Though now it is known as isotretinoin, and also marketed as Claravis, Sotret and Amnesteem. This oral medication is taken once or twice daily to help decrease the acne, usually in teens and young adults.

This age group is the very core of the childbearing age potential. The problem is that Accutane or isotretinoin can cause severe birth defects.

The medication is so teratogenic, that even one dose can cause major problems. People who wish to take this acne medication must use two methods of birth control for one month prior to the treatment, the entire treatment cycle, and a month after the treatment in order to prevent pregnancy and put their potential pregnancy at grave risk of life threatening birth defects. 

To combat these risks, the manufacturers came up with the IPledge program. This is for everyone who takes isotretinoin. This program includes separate requirements for women and men. Even if you are a woman who can't get pregnant, such as someone who has had a hysterectomy, you still have to participate in the IPledge program. Some of the requirements, other than birth control, include monthly pregnancy tests during treatment, prescription parameters, etc. There are several reports that this system is not working as well as had hoped, while birth defects are down, there are lower numbers of people taking medication as prescribed.


If you are considering pregnancy or are pregnant, this medication is not the medication that you would want to use to try to deal with your acne or skin break outs. You would need to decide whether the 16-20 week course of treatment was worth the wait, if you were not yet pregnant, or if you would do it after pregnancy.

What Happens if You Take Isotretinoin While Pregnant

About 42% of infants born after being exposed to isotretinoin while pregnant had some form of birth defect or died. Of those infants who had Accutane birth defects, we saw both "internal and external abnormalities such as cleft palate, missing ears, facial dysmorphism and central nervous system malformations."

The pregnancy labeling category for when Accutane was available was Category X. This means that there were known deformities due to the medication and it should not be taken during pregnancy. There is also information that in the month or two after stopping isotretinoin, pregnancy is also at risk.

Alternatives to Accutane

While Accutane is not available right now, Isotretinoin is available. Neither of these is good while pregnant or planning a pregnancy in the close future. So, what can you do about severe acne? There are alternatives that can be used, which ones would depend on if you were pregnant or planning a pregnancy. This is a discussion to have with your dermatologist and potentially as a part of your preconceptional health visit with your obstetrician or midwife.

In the end, you will be glad that you either waited to treat your acne until after your baby was born, or that you delayed pregnancy until after your treatment was finished. This is the best for you and your pregnancy.


Baldwin HD. "Pharmacologic Treatment Options in Mild, Moderate, and Severe Acne Vulgaris." Semin Cutan Med Surg. 2015 Sep;34(5S):S82-S85.

Drug Watch: Accutane. October 2015. Last Accessed February 23, 2016.

Pierson JC, Ferris LK, Schwarz EB. We Pledge to Change iPLEDGE. JAMA Dermatol. 2015 Jul;151(7):701-2. doi: 10.1001/jamadermatol.2015.0736.

Webster GF. "Isotretinoin: Mechanism of Action and Patient Selection." Semin Cutan Med Surg. 2015 Sep;34(5S):S86-S88.

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