Botox During Pregnancy at a Glance
- Botox and Pregnancy: Use Not Recommended
- Evidence: No reliable data on safety for mother or child
- Risks: Possible embryotoxic effects in animal studies; unknown placental transfer
- Breastfeeding: No data on passage into breast milk
- Recommendation: Avoid Botox, fillers, and all other injectables during pregnancy and breastfeeding
- Alternatives: Non-invasive skincare and medical supervision for legitimate therapeutic needs
Table of Contents:
Why This Topic Matters
Many of my patients wonder what happens if they become pregnant while receiving regular aesthetic Botox treatments. Those who have been treating frown lines or forehead wrinkles with botulinum toxin for years often ask whether they need to pause their routine or can safely continue.
Even though Botox is widely considered a low-risk cosmetic procedure, the situation changes once pregnancy begins.
It’s also worth noting that Botox is used for medical indications—for example, to treat migraines or muscle spasms. For these patients, stopping treatment can be challenging. All the more reason to understand what is actually known about the safety of Botox during pregnancy.
What Science Knows
The evidence on Botox use during pregnancy is limited but not entirely absent. A few case reports and retrospective analyses exist—mostly involving women treated with botulinum toxin for medical conditions such as migraine or muscle spasms.
In these reports, there was no increased risk of birth defects or premature delivery; most infants were born healthy.
However, these findings have limited reliability, as they come from small, uncontrolled case series. There are no controlled studies involving pregnant women.
In animal studies, high doses were linked to delayed bone development and lower birth weight, suggesting a potential risk. Whether these effects occur in humans remains unclear. It also remains unknown whether the large botulinum toxin molecule can cross the placental barrier or enter breast milk.
The research consensus therefore is:
Risks and Uncertainties
Although no harmful effects of Botox during pregnancy have been documented so far, several key questions remain unanswered. Botulinum toxin is a large protein molecule that likely does not actively cross the placental barrier, but a minimal systemic diffusion after injection cannot be ruled out.
It is also unclear whether trace amounts might pass into breast milk, as reliable data are lacking. Animal studies at very high doses have shown delayed bone formation and lower birth weight, suggesting a potential risk—even though these doses are far above those used in aesthetic medicine.
Because many of these questions remain open, the precautionary principle applies: Botulinum toxin treatments should be avoided unless there is a compelling medical indication.
Recommendations from Medical Societies
Aesthetic Botox Treatments
Although Botox for wrinkle treatment is not officially listed as contraindicated during pregnancy, both the manufacturers and all professional medical societies advise against its use. The reason is the lack of reliable data—without solid studies, no reputable institution can recommend the treatment.
As stated in the product information for the aesthetic botulinum toxin preparation Vistabel (translated from German):
The S1 Guideline “Aesthetic Botulinum Toxin Therapy” issued by the Association of the Scientific Medical Societies in Germany (AWMF) goes even further, classifying pregnancy and breastfeeding as absolute contraindications (translated from German):
Similar positions are found internationally. Both the American Academy of Dermatology (AAD) and the British Association of Dermatologists (BAD) recommend suspending aesthetic botulinum toxin treatments during pregnancy and breastfeeding.
Botox for Neurological Conditions
Botulinum toxin is used not only for cosmetic purposes but also medically to treat neurological conditions such as spasticity, dystonia, tremor, and chronic migraine. For patients who become pregnant, the difficult question arises whether ongoing therapy can be continued or should be paused.
The manufacturer of the botulinum toxin preparation Botox, approved for neurological indications, includes the following restriction in its product information (translated from German):
In a very similar wording, the portal embryotox.de, run by the Embryotoxicology Advisory Center at the Institute of Clinical Pharmacology and Toxicology of Charité University Hospital, summarizes its recommendation as follows:
The position is clear: even for medical indications, the precautionary principle applies. Treatment should be considered only in exceptional cases—for example, when the symptom burden is severe and no safe alternative exists. In most cases, it should be postponed until after pregnancy and breastfeeding.
My Medical Assessment
I fully support these recommendations.
- No Botox treatments should be performed during pregnancy—especially not for purely aesthetic reasons.
- For medical indications such as chronic migraine or spasticity, the decision must be made on an individual basis, balancing the impact on quality of life against the potential risk of botulinum toxin use.
For cosmetic purposes, waiting is the safest choice. For medical conditions, all non-harmful alternatives should be explored first. One example is chronic migraine: according to the current guideline of the German Society of Neurology, several alternative treatment options are available that avoid the use of botulinum toxin, monoclonal antibodies, and other potentially embryotoxic substances (see the linked PDF, pp. 44 and 111).
What to Do If You Discover You’re Pregnant After a Botox Treatment
This situation is not uncommon and understandably causes concern. According to current research, there is no evidence that a Botox treatment shortly before or in early pregnancy harms the baby. In the documented cases so far, no malformations or developmental disorders have been observed.
Medical societies advise affected women not to receive further injections and to discuss next steps with their physician. No special treatment or monitoring is usually necessary. The pregnancy can proceed normally, but further Botox treatments should be avoided during breastfeeding until it is completed.
Other Aesthetic Treatments During Pregnancy and Breastfeeding
Not only Botox, but all minimally invasive aesthetic procedures should be avoided during pregnancy and breastfeeding. This includes hyaluronic acid fillers, PRP treatments, polynucleotides, PDO threads, mesotherapy, and microneedling.
The reason is not only the lack of safety data, but also several specific medical risks. Most hyaluronic acid fillers contain the local anesthetic lidocaine, which is contraindicated in pregnancy and breastfeeding. Even minimal exposure could theoretically reach the fetal circulation.
If a complication occurs after filler treatment—such as vascular compression or an allergic reaction—the standard management would be to dissolve the filler with hyaluronidase (Hylase). However, Hylase is also contraindicated in pregnant and breastfeeding women due to the absence of safety data. This eliminates the primary therapeutic option for managing such complications.
Moreover, the infection risk associated with any injection should be strictly avoided during pregnancy. Even minor local inflammation can impose additional physical stress, affecting circulation and well-being. Small interventions can also activate the sympathetic nervous system, temporarily raising heart rate and blood pressure—burdens that are unnecessary during pregnancy.
Considering all these factors, the conclusion is clear:
Conclusion
In summary:
- Aesthetic treatments should be avoided during pregnancy and breastfeeding.
- For functional or neurological conditions treated with botulinum toxin, all safe alternative therapies should first be explored in close consultation with the treating physician. Botox may only be considered in exceptional cases where there is a clear medical necessity and no viable alternatives.
- If a woman becomes pregnant during ongoing Botox therapy, current evidence suggests no risk to the baby. However, treatment should be stopped immediately, and the next steps discussed with a physician.
Frequently Asked Questions
No birth defects have been observed in humans. However, animal studies using very high doses have shown embryotoxic effects such as delayed bone development and lower birth weight. These findings support the precautionary principle—that is, avoiding Botox during pregnancy.
Based on current evidence, there is no risk to the baby. Studies show no signs of birth defects or developmental problems when botulinum toxin was administered shortly before or in early pregnancy. The key is to avoid further injections and discuss next steps with your treating physician.
There is no fixed waiting period, but it is generally recommended to wait at least three months after a Botox treatment before planning a pregnancy. By that time, the botulinum toxin is fully metabolized, and there is no remaining risk to the embryo.
During breastfeeding, aesthetic Botox treatments should be completely avoided, as it is unclear whether the toxin passes into breast milk. Medically necessary treatments may be considered in consultation with a physician if no suitable alternatives are available. Once breastfeeding has ended, the treatment can be resumed without restriction.
No. Botulinum toxin has no effect on fertility. It acts only locally at the injection site and does not enter the bloodstream in quantities that could affect the ovaries, hormone balance, or sperm quality. Neither clinical studies nor case reports show any link between Botox and reduced fertility.
About the Author:
Dr. med. univ. Eva Maria Strobl is the owner of LIPS and SKIN Aesthetic Medicine practice in Munich. She is a trained specialist in general medicine (MedUni Vienna) and has over 10 years of specialization in non-surgical aesthetic procedures. Dr. Strobl is a member of the German Society for Aesthetic Botulinum Therapy e.V. (DGBT), the German Society of Anti-Aging Medicine e.V. (GSAAM) and of Network Global Health. She publishes regularly on her blog and on DocCheck.
Sources for This Content:
Sommer et al, Botulinumtoxin in der ästhetischen Medizin, Thieme
Gauglitz et al, Leitlinie Ästhetische Botulinumtoxin-Therapie, AWMF
Diener et al, Leitlinie Therapie der Migräneattacke und Prophylaxe der Migräne, DGN
Allergan Aesthetics, Fachinformation Vistabel, Link
Allergan, Fachinformation Botox, Link
