Introduction:
Cosmetics are a need in our everyday lives, and they are primarily utilised by young ladies, including pregnant ladies. According to recent cross-sectional studies, 60-80 percentage of pregnant women utilise cosmetics such as facial cleaning, mascara, lipstick, make-up remover, eye pencil etc (1, 2). Cosmetics and beauty products are not particularly beneficial to one's physical health and continued use can cause serious health adversities (3). Chemicals included in cosmetic products have a direct impact on the human body, which enters the blood stream and potentially harm women's fertility and reproductive health, which has been linked to adverse pregnancy outcomes (1, 2). Patients who are pregnant should avoid using certain cosmetic topical treatments with unclear safety data, such as tazarotene and hydroquinone (4). Many active compounds used in cosmeceutical and cosmetics that are applied topically during pregnancy have minimal research on their safety and efficacy. Cosmeceutical, unlike cosmetics are not inert to the skin, dermatologists should be cautious when prescribing them to pregnant women (5). Bibliometrics is a novel and popular scientific field investigating academic literature and analysing publication trends and patterns in a certain area(6). Despite the growing popularity of scientometric and bibliometric assessments of scientific evidence, there is no research in dermatology and medical literature that examines the bibliometric features of articles on use of cosmetics during pregnancy. So far there was no study to compare our results within the literature.
Aim of this study was to conduct a systematic bibliometric review of the literature on the use of cosmetics during pregnancy and produce a trend analysis in this broad field.
Methods
Search tool and strategy
Study design: Retrospective bibliometric analysis.
Inclusion criteria: All the documents published between November 1962 and May 2021 were included in the study. Letter to editor and notes also included in this study.
Exclusion criteria: Manuscript published after May 2021 were excluded from the study.
To acquire articles on the cosmetics usage during pregnancy, the Scopus database (https://www.scopus.com, Elsevier, Amsterdam, The Netherlands, 2021) was used. Scopus is the world's largest abstract and citation database for peer-reviewed literature, with the most comprehensive analysis of published papers in the field of health science(7). The descriptive bibliometric analysis was carried out using Scopus's built-in functions. On 17 May 2021, the search was performed using the keywords
"cosmetics" and "pregnancy" as a search term to retrieve all possible papers aggregated within the group from the Scopus database. All the documents published between November 1962 and May 2021 were included in the study. For the analysis of the pages, average number of articles, references, authors, organisations, and citations each year, we exported information with reference records (all article editors and references) from the Scopus database into Microsoft Excel(USA) in CSV format, and used the Excel generate text and statistical functions to determine yearly averages. We also produced bibliometric network maps that depicted the relationships and connections between countries, most commonly used indexed keywords. In this research, we used VOS viewer resource freeware (Centre for Science and Technology Studies, Leiden University, Leiden, The Netherlands to create bibliometric network visualisation maps. The role of the software is connecting the nodes in the network to the clusters; thus, in a way, a cluster is a set of nodes that are loosely related. As the value of this parameter grows, the number of clusters also increases. Each cluster is represented accordingly by a color. The terms that are more important have larger circles, and terms that were strongly related to each other were closer. Lines between terms indicate, by thickness, a stronger link between the two terms (8, 9).
Results
Total number of publications
The Scopus database produced 902 documents during our search. It was found that 246 items were open access. Maximum publications were original articles (n = 632; 70.06%) followed by review (20.73%).
The USA with 284 items was the leading country contributing to the literature followed by UK, Germany and France (67, 54 and 42 respectively). The majority of countries ranked by the total number of publications were developed countries [Figure 1].
 |
 |
Fig. 1: Top ten countries publishing cosmetic usage during pregnancy related publications by the total number of documents |
Fig. 2: Year with the maximum number of publications |
We found that the maximum number of publications (57) are in the year 2017 [Figure 2].
Research areas, journals, institutions, and authors
Calafat AM from National Center for Environmental Health, United States was found to be the most productive author with 14 papers amounting to 1.55% of total, followed by Andersen FA from Cosmetic Ingredient Review, Washington, D.C., United States and Paumgartten, F.J.R. from Fundacao Oswaldo Cruz, National School of Public Health, Rio de Janeiro, Brazil (0.66% and 0.66%). Majority of the authors were from developed countries. [Table 1].
| Table 1: Top ten authors by record count |
| Author |
Institution |
Country |
Record count |
% |
Calafat, A.M. |
National Center for Environmental Health, United States |
United States |
14 |
1.55 |
Andersen, F.A. |
Cosmetic Ingredient Review, Washington, D.C., United States |
United States |
6 |
0.66 |
Paumgartten, F.J.R. |
Fundacao Oswaldo Cruz, National School of Public Health, Rio de Janeiro, Brazil |
Brazil |
6 |
0.66 |
Belsito, D.V. |
Columbia University, Department of Dermatology, New York,
United States |
United States |
5 |
0.55 |
Cordier, S. |
Inserm, Paris, France |
France |
5 |
0.55 |
Hauser, R. |
Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, United States |
United States |
5 |
0.55 |
Meeker, J.D. |
University of Michigan School of Public Health, Ann
Arbor, United States |
United States |
5 |
0.55 |
Souza, C.A.M. |
Fundacao Oswaldo Cruz, Department of Biological Sciences, Rio de Janeiro, Brazil |
Brazil |
5 |
0.55 |
Spyker, D.A. |
Oregon Health & Science University, Department of Emergency Medicine, Portland, United States |
United States |
5 |
0.55 |
Chahoud, I. |
Charit Universitatsmedizin Berlin, Berlin, Germany |
Germany |
4 |
0.44 |
Centers for Disease Control and Prevention was found to be the most productive institution, with 16 items, followed by the University of California, San Francisco (14), whereas National Toxicology Program NTP had the least number of contributions among the top ten institutions. Many of the organisations were from developed countries.
The most researched fields in the literature related to use of cosmetics during pregnancy were found to be Medicine, followed by Pharmacology, Toxicology and Pharmaceutics as well as Biochemistry, Genetics and Molecular Biology (693, 155, 96) [Table 2].
|
Table 2: Top ten institutions and research areas by number of publications in the literature related to cosmetic usage during pregnancy |
| Institutions |
Number of Documents |
Research areas |
Number of publications |
Centers for Disease Control and Prevention |
16 |
Medicine |
693 |
University of California, San Francisco |
14 |
Pharmacology, Toxicology and Pharmaceutics |
155 |
Harvard T.H. Chan School of Public Health |
14 |
Biochemistry, Genetics and Molecular Biology |
96 |
Harvard Medical School |
13 |
Environmental Science |
88 |
Inserm |
12 |
Chemistry |
25 |
Cosmetic Ingredient Review |
11 |
Agricultural and Biological Sciences |
23 |
National Institute of Environmental Health Sciences NIEHS |
11 |
Neuroscience |
17 |
National Center for Environmental Health |
10 |
Nursing |
16 |
Fundacao Oswaldo Cruz |
10 |
Chemical Engineering |
13 |
National Toxicology Program NTP |
9 |
Immunology and Microbiology |
11 |
International Journal of Toxicology was the leading journal contributing to the literature on cosmetics use during pregnancy and covered 1.44% of all documents followed by Obstetrics and Gynaecology, Reproductive Toxicology (1.33%, 1.21) [Table 3].
| Table 3: The first ten-journals according to the number of published documents |
| Journal name |
Number of publications |
% |
International Journal of Toxicology |
13 |
1.44 |
Obstetrics and Gynecology |
12 |
1.33 |
Reproductive Toxicology |
11 |
1.21 |
International Journal of Environmental Research and Public Health |
10 |
1.10 |
Environment International |
9 |
0.99 |
Food and Chemical Toxicology |
9 |
0.99 |
Clinical Toxicology |
7 |
0.77 |
Environmental Health Perspectives |
7 |
0.77 |
Journal of Cosmetic Dermatology |
7 |
0.77 |
Science of The Total Environment |
7 |
0.77 |
Progression of publications and citations
We conducted a citation review of the literature on cosmetics use during pregnancy during the last decade for 902 articles. The most cited article was entitled The plasticizer diethylhexyl phthalate induces malformations by decreasing fetal testosterone synthesis during sexual differentiation in the male rats by Parks, LG et al published in Toxicological Sciences cited 595 times in 2000 followed by Endocrine disrupting chemicals and disease susceptibility by Schug, T.T., published in the Journal of Steroid Biochemistry and Molecular Biology, with 587 citations in 2011. [Table 4].
|
Table 4: The ten most cited publications in use of cosmetic during pregnancy literature
|
| Article |
Author |
Journal name |
Total citations |
Year of publication |
The plasticizer diethylhexyl phthalate induces
malformations by decreasing fetal testosterone synthesis during sexual
differentiation in the male rat |
Parks, L.G. et al |
Toxicological Sciences |
595 |
2000 |
Endocrine disrupting chemicals and disease susceptibility |
Schug, T.T. |
Journal of Steroid Biochemistry and Molecular Biology |
587 |
2011 |
Human skin pigmentation: Melanocytes modulate skin color
in response to stress |
Costin, G.-E. et al |
FASEB Journal |
571 |
2007 |
MR procedures: Biologic effects, safety, and patient care |
Shellock, F.C. et al |
Radiology |
415 |
2004 |
The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery |
Neudecker, J. et al |
Surgical Endoscopy and Other Interventional Techniques |
403 |
2002 |
Polycystic ovary syndrome |
Azziz, R. et al |
Nature Reviews Disease Primers |
377 |
2016 |
2014 annual report of the American association of poison control centers National Poison Data System (NPDS): 32nd Annual Report |
Mowry, J.B. et al |
Clinical Toxicology |
320 |
2015 |
2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th Annual Report |
Bronstein, A.C. et al |
Clinical Toxicology |
318 |
2011 |
N-Nitroso Compounds And Childhood Brain Tumors: A Case-Control Study |
Preston-Martin, S. et al |
Cancer Research |
285 |
1982 |
2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS) |
Bronstein, A.C. et al |
Clinical Toxicology |
263 |
2007 |
Bibliometric network analysis
We noticed that the most commonly used keywords in this area were Human, Female, Cosmetic, and Cosmetics after conducting a systematic keyword study. We created a keyword network visualisation map with the keyword Human and Female in the middle and connected it to the other keywords [Figure 3].
 |
Fig. 3 Keyword network of cosmetic usage during pregnancy literature |
 |
Fig. 4 Countries network of literature on the use of cosmetic during pregnancy |
We also created a bibliometric countries network visualization map of produced documents; this revealed two main centers, including USA, and United Kingdom in which the United States of America was in the middle and linked to the other countries as a result of our comprehensive country analysis [Figure 4].
Discussion
Physiological changes in women, including an increase in testosterone levels, occur during pregnancy. This could cause acne vulgaris to develop or worsen, as well as an increase in hair growth in various areas of the body (10, 11). Exposure to cosmetic products by pregnant women (such as cosmetologists and hairdressers) has been linked to preterm birth, perinatal death, miscarriage, short for gestational age (SGA), low birth weight, and other unfavourable pregnancy outcomes (12, 13). Chemical/ ingredients which are used in cosmetics has lot of side effects on body. Lead can be found as an impurity in lipsticks and eye powders such as kajal, has been associated with high blood lead levels in women and children, which are toxic to the body. Pregnant women are at higher risk because it can easily cross the placenta and reach the fetus brain. It can also be transferred to infants through lactating mother's milk (14). Because the majority of cosmetic items are applied directly to the skin, harmful substances can pass through the epidermal barrier and into the dermis of the human body, potentially causing damage to women's fertility and reproductive health. Some of these substances have been linked to poor pregnancy outcomes. In a case-control research conducted in France, mother prenatal exposure to phenols (2,4-dichlorophenol and 2,5-dichlorophenol) was found to be inversely associated to male birth weight (1,15). According to a New York State retrospective cohort research, licenced cosmetologists are more likely than licenced realtors to have low birth weight babies (1,16).
Safety of skin care products during pregnancy
Salicylic acid: It is an ingredient in a number of cosmetic and acne products. Researchers evaluated the results of women who took low-dose of acetylsalicylic acid throughout pregnancy and found no increase in the baseline risk of adverse events such as significant malformations, preterm birth, or low birth weight. There have been no studies on topical usage in pregnancy; however, as such a small amount is absorbed via the skin, it is unlikely to pose any damage to a growing foetus (10,17).
Glycolic acid: Glycolic acid is an alpha hydroxy acid which is found in many cosmetics used to treat acne. Several animal studies have shown that high dosages of glycolic acid, far higher than those used in topical cosmetic treatments in humans, have negative reproductive effects. There have been no studies on the use of glycolic acid in human pregnancy; however, using topical glycolic acid during pregnancy should not be a cause for worry because only a small quantity is predicted to be absorbed systemically (10,18,19).
Sunscreens: Sunscreens are widely used to protect the skin from the sun's harmful rays, and they have been found to be relatively safe in animals. The products' cutaneous and systemic absorption is quite low. Sunscreens have been used to treat or prevent melasma in pregnant women, with no documented side effects (10,20-22).
Skin-lightening agents: Hydroquinone is a topical depigmenting substance used in the treatment of chloasma and melasma, as well as a skin-whitening ingredient in cosmetics. A single investigation on the use of hydroquinone during pregnancy found no increase in adverse outcomes; however, the number of pregnant women in the study was limited. Hydroquinone use during pregnancy does not appear to be linked to an increased risk of significant abnormalities or other side effects, according to the existing evidence. However, because of the high absorption relative to other products, it is advisable to avoid exposure until more research can be done to ensure safety (10,23,24).
Self-tanning agents: Dihydroxy acetone is a colour additive used to create an artificial tan in self-tanning products. Because dihydroxy acetone binds to amino acids in the stratum corneum, colour emerges after topical administration. These products include dihydroxy acetone in concentrations ranging from 1% to 15%, and systemic levels are modest (0.5%) when administered topically, therefore, use during pregnancy would not be of concern (10,25).
Some beauty products, including as nail paint and nail polish remover (advisable to use products phthalate-free) and hair colouring, should be avoided during pregnancy and substituted with products that have less toxic elements. Delmaar et al. discovered that using spray deodorants resulted in higher phthalate exposure than using non-spray deodorants (26). In several countries, such as France and Denmark, health officials advise women about results of chemical exposure from cosmetics use during pregnancy (27). Woman are the one who are using more cosmetics than men. Pregnant women are especially vulnerable to the hazards of cosmetic endocrine disruptors. Any prevention and awareness plan aiming at limiting pregnant women's exposure to endocrine disruptors must include advice from perinatal health specialists (such as community pharmacists, general practitioners, obstetricians, etc.), risk perception of these products, changes in cosmetic product use habits during pregnancy (2). Education about use of cosmetics during pregnancy is necessary. During pregnancy, women should limit their use of cosmetics as much as possible (1).
Most of the authors and organisations on the top ten productive lists were from developed countries, according to our findings. We found that Centers for Disease Control and Prevention is first among the top ten institutions reporting research investigating cosmetic use during pregnancy (16) [Table 2]. We found that the maximum number of publications (57) are in the year 2017 [Figure 2]. So far as we know, there has been no study investigating bibliometric features of literature on the use of cosmetic during pregnancy.
Conclusion
Due to increasing consciousness about beauty, people are using more cosmetic products, which results in increasing adverse events. Cosmetic and beauty products have both benefits and side effects on human health. Cosmetic products causes endocrine disruption among pregnant women. Therefore, cosmetics use during pregnancy needs to be cautious. Education about cosmetics usage during pregnancy is necessary. Through the research we found that less contribution from India. More consideration is needed to be given by the Indian authors /researchers to conduct quality research on use of cosmetics during pregnancy and determine which cosmetic products may be responsible for elevated risk.
Financial support and sponsorship: No funding was received for this study.
Conflicts of interest: There are no conflicts of interest.
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