Pregnancy-Safe Skin Care Guidelines: Expert Consensus Recommendations

Background and Rationale

Pregnancy is associated with profound hormonal, immunological, and metabolic changes that directly affect the skin. These changes can manifest as physiologic alterations (e.g., hyperpigmentation, striae), exacerbation of pre-existing dermatologic diseases, or pregnancy-specific dermatoses. Safe and effective skin care during pregnancy is critical, as many commonly used dermatologic ingredients cross the placental barrier, lack human safety data, or pose teratogenic risks.

Despite the high prevalence of dermatologic concerns in pregnancy, current clinical guidance remains fragmented, variable across regions, and often based on expert opinion rather than standardized consensus. To address this gap, we employed a structured Delphi expert consensus process to develop evidence-informed, practical, and regionally adaptable guidelines for pregnancy-safe skin care.

Methods: Delphi Consensus Process

A structured three-round Delphi methodology was used to achieve consensus among a multidisciplinary panel of dermatologists, obstetricians, and pharmacology experts.

2.1. Panel Composition

N = 25 experts

Representatives from dermatology, maternal-fetal medicine, and clinical pharmacology

Minimum of 5 years of clinical experience

Geographic representation from MENA, Europe, and Asia

Steps in the Delphi Process Round 1: Exploration

Experts provided open-ended responses on:

Essential principles of pregnancy-safe skin care

Ingredient safety classifications

Preferred management of common dermatologic conditions

Cultural and regional care considerations

A qualitative analysis was performed to derive core themes.

Round 2: Structured Statements

75 draft statements were generated and rated using a 9-point Likert scale

1-3: Disagree

4-6: Uncertain

7-9: Agree

Consensus defined as ≥ 75% of experts rating 7-9.

Round 3: Refinement and Final Voting

Statements near consensus were revised for clarity.

Final voting achieved consensus on statements, forming the basis of the guidelines.

Inclusion criteria

• Board-certified dermatologist or plastic surgeon OR physician practicing aesthetic medicine.

• Minimum of 5 years of clinical experience.
• Practicing within Egypt or the Middle East and North Africa (MENA) region.
• Willingness to participate in Delphi rounds and provide expert ratings.
• Ability to read and respond to surveys in English.

Exclusion criteria

Inability or unwillingness to complete Delphi rounds.

• Lack of clinical experience with Pregnant ladies.
• Industry representatives without direct clinical practice.