First off, thanks to Professor Emily Oster for the inspiration behind this article. In over 1000 articles I’ve written for this site, I’ve never directly tackled the issue of botulinum toxin (the active ingredient in the popular anti-wrinkle injections behind BOTOX®, XEOMIN® and Jeuveau® (#newtox)).
I did write about this topic, albeit tangentially, in this silly article when Kylie Jenner was rumored to be pregnant with her first child!
Botox in pregnancy
While no doctor will encourage you to get botox injections for cosmetic reasons while pregnant, it doesn’t mean you can’t or you shouldn’t. Simply put, there isn’t a large randomized controlled study comparing women getting botox while pregnant vs women not getting botox while pregnant.
Yes, a large study of this type would answer the question of whether botox was safe in pregnancy. But it will never happen. For obvious reasons, no one would conduct or fund a study that could potentially affect a baby. So we’re left to extrapolate from this retrospective study (studying patients after the fact), animal studies or personal stories of patients that have gotten botox during pregnancy.
As a plastic surgeon, I have injected patients with BOTOX® or XEOMIN® when they didn’t realize they were pregnant. And the patient and their baby turned out fine. So while there’s no evidence of a problem in being injected with these products while pregnant, it’s impossible to say they’re safe beyond a doubt. But there’s no evidence of birth defects associated with cosmetic botox injections that exceeds the risk in the general population. It’s a calculated risk similar to the risks we take walking across the street, not wearing a mask outside or speeding on the highway.
Botox while breastfeeding
This one is a little easier. Based on the LactMed database that evaluates medications and their presence in breast milk or their affect on the child, the evidence is quite clear:
“No data exist on the medical use of onabotulinumtoxinA [BOTOX®] during breastfeeding. However, it is not detectable systemically after intramuscular use, thus excretion into breast milk is considered unlikely. Breastfeeding appears to protect infants against botulism.”
In other words, botox isn’t detectable in breast milk. To further drive home the point, even in a patient that became ill after ingesting botulinum from tainted food (not cosmetic botox injections), she didn’t pass the toxin along to her fetus. So even if it’s present in high concentrations systemically during an active infection and still doesn’t reach the breast milk, then it’s even less likely to reach breast milk when present in lower concentrations associated with cosmetic, localized injections.
As an aside, botulism from tainted food is the same reason you don’t feed honey to a baby before the age of one because of the presence of the botulinum bacteria. After age one, children are better equipped to ward off the infection.
There you have it. The data. And now you can make an informed decision based on that.