There are both cosmetic and medical uses for botulinum toxin, a bacteria that is marketed under the brand name Botox. New moms and moms-to-be often have questions about having Botox injections during pregnancy or while they are breastfeeding. We often hear questions such as “Does Botox cause birth defects?” and “What happens if you get Botox in early pregnancy?” or ”Is Botox safe while breastfeeding?”
More research would be needed to answer all these questions. Today we will provide a short history of Botox and the potential risks of its use and information that may be helpful for you to draw your own conclusions about the use of Botox during pregnancy and while breastfeeding.
The Origin And Uses Of Botox
The name botulinum (toxin) may sound a bit familiar to you as it is where the illness “botulism” derived its name. The CDC describes botulism as a serious but rare illness that can be fatal and is usually contracted after eating contaminated foods that have not been “canned” or preserved properly. Some of the symptoms of botulism include:
- Vision problems;
- Breathing issues;
- Muscle paralysis or weakness;
- Death.
The botulinum toxin, when used in small doses, is quite safe and when injected into targeted facial muscles, paralyzes them so they relax and smooth out the wrinkles. It is also used medically to treat migraine headaches, urinary incontinence, spastic muscle disorders, and excessive sweating.
The History Of Botox
Botox was used for medical purposes before the cosmetic uses were discovered. In 1978 an ophthalmologist began using it in trials to treat patients with strabismus (crossed eyes) under the name Oculinum. The FDA approved it in 1989 to treat this eye issue as well as for blepharospasm (eye twitching) The company Allergan acquired it from the doctor a few years later and eventually relabeled it as Botox.
The cosmetic benefits of Botox were discovered serendipitously by a Canadian eye doctor who was using it to treat a patient with blepharospasm. One of her patients came in for her routine treatment and then complained when the doctor did not put an injection into her forehead (like she did the time before). The patient said she wanted another injection on her forehead because it made her forehead lines go away.
The eye doctor shared this information with her husband who was a prominent dermatologist and together they began to do some experiments and published a study in 1992 on the cosmetic uses for Botox. It was used as a “off label” for the treatment of wrinkles for years before it was FDA approved in 2002 as BOTOX® Cosmetic for treating forehead lines. The FDA has now approved Botox to cosmetically treat forehead lines, frown lines, and crows feet.
Botox And Pregnancy
BOTOX® Cosmetic has been the subject of over 4700 published peer-reviewed articles describing its safety and effectiveness in both medical and scientific journals. It has become one of the most studied and researched treatment available today. But, what is known about the effects of Botox if used during pregnancy? Honestly, not very much.
As expected, there have not been any controlled studies dedicated to the use of Botox on pregnant women or women who were breastfeeding.
As you have reviewed above, Botox is made from a toxin that is known to be dangerous if exposed to enough of it and the jury is still out on its migration capability. Historically, Botox is expected to stay in the area that is injected although it can migrate a bit – 3-4 centimeters in the facial area.
It is not known to enter a person’s system or bloodstream and therefore it would be unlikely that it could travel into the placenta of a pregnant woman and affect a developing fetus. But the truth is we just do not know. The most common answer you will find when researching the subject of using Botox during pregnancy is that it should be used with caution and to consult with your doctor before using it.
Botox Is Rated As A Category C Drug For Pregnant Women
The FDA categorizes drugs in relation to their safety for use during pregnancy. These categories range from “category A” drugs which are considered safe to use during pregnancy to “category X” drugs which could be fatal. According to the FDA, Botox is a category C drug which means that no controlled studies on women were performed and it is recommended that it be used only when the benefits outweigh any potential risks.
The Botox website provides a statement confirming that no studies or data are available outlining developmental risks associated with Botox use during pregnancy.
The information on the website did outline that studies done on pregnant rats and rabbits indicated the small amounts (as used in locations like the face) given three times during their pregnancy did not affect fetal development in any way. However, when large amounts were used every day it caused toxicity to the mother and affected fetal weight and skeletal development (they were given 16x the human dose)
Positive Reports of Botox Use During Pregnancy
Some women use Botox for cosmetic purposes only while others may be receiving Botox treatments for medical purposes. Data was gathered on 45 women who were being treated with Botox to address migraines who became pregnant during treatment.
13 women discontinued the use of the medication and the remainder continued their migraine treatments for the duration of their pregnancy. Among the 32 remaining women, there was one miscarriage and 31 healthy full-term babies who were free from any defects. In the United States, statistics show that approximately 1 in 10 pregnancies end in miscarriage.
Another source of data that was gathered for review looked at 232 cases of Botox usage over 24 years and there were no differences in pregnancy complications or fetal outcomes when compared to statistics in the United States as a whole.
Botox Use While Breastfeeding
Getting Botox injections while breastfeeding is also a highly controversial subject. In fact, it seems the more research you do on this topic, the more confusing it becomes. Even though testing breast milk seems like it would be an easy way to study the effects of Botox on breast milk, there is a lack of research to prove or disprove any of the current beliefs about the transfer of toxins into the breast milk.
Most sources suggest that Botox is a localized treatment and does not travel throughout the body. It can migrate to nearby locations and the higher the amount used the farther it can travel. For instance when used for cosmetic purposed on the face if the patient immediately rubs or massages that area, the Botox can travel a few centimeters but not much further.
Case Study Showed No Evidence Of Botulinum Toxin In Her Breast Milk
A recent case study reviewed a nursing mother who ingested tainted salmon eggs which resulted in a severe case of botulism. After testing both her breast milk and the baby, there was no botulinum toxin detectable in either the mother’s breast milk or the baby.
The doses of the toxin are so minuscule in cosmetic use when compared to those that cause botulism that it makes a case that it is safe to breastfeed while using cosmetic Botox.
Since there has not been any strategic research on pregnant and nursing mothers, there is no definitive answer to the question “Is it safe to use Botox during pregnancy”? or “Is Botox safe while breastfeeding?”
Hopefully, this article has provided some helpful information that will assist you in coming to your own conclusion about what is best for you. The best recommendation I can offer would be to consult with your doctor, do your research and make an informed decision.
If you are interested in learning more about Botox injections for cosmetic use, please, contact SurgiCare Arts today and set up a consultation.
Angelina Postoev, MD, FACS, a triple-board certified cosmetic surgeon, and Christopher Ibikunle, MD, FACS, offer Botox® cosmetic injection treatments for women and men in their offices located in Buckhead (Atlanta), Lawrenceville, Suwanee, Johns Creek, and the surrounding areas of Georgia. Additionally, we now have office locations in Tampa, Florida and Hudson, Florida.
