Occupational Hazards for Pregnant People in the Beauty Industry

Is your nail and hair salon your healthy sanctuary for self-care? Think again, especially if you are planning a pregnancy. Did you know that your salon or spa may use dozens of toxic chemicals? More harmful chemicals than you might find in a hardware store or factory. In nail polish, there are acrylates in artificial nail products, glues, parabens, toluene, formaldehyde, and phthalates. Cancer-causing chemicals such as volatile organic toluene, persulfates, and formaldehyde fill the ingredient lists of hair dyes and hair care products. The beauty industry continuously concocts new chemical combinations for the latest beauty trend or treatment. Yet, the Food and Drug Administration (FDA) labels beauty products as consumer products. The FDA does not apply the same health and safety testing requirements for consumer products as they do for medications or drugs.

What about the people working day in and day out in the toxic chemistry experiment that is hair and nail salons? According to U.S. Centers for Disease Control and Prevention (CDC) estimates, there are currently around 400,000 active nail technician licenses and roughly 600,000 employed hairdressers in the United States. Most of these workers are women of reproductive age, and many are foreign-born or people of color.

Pregnant women’s exposures to synthetic chemicals are doubly toxic because many chemicals can be transferred from mother to child across the placenta and via breast milk. Fetal exposure to synthetic chemicals may disrupt development even at very low levels. The timing of this toxic exposure can cause birth defects, chronic health conditions such as asthma and allergy, and even changes at the (genetic) DNA level, passed on to future generations.

We already know that some chemicals on this scary-sounding laundry list of compounds are associated with cancer or reproductive harm. Studies have documented adverse birth outcomes among hairdressers, such as birth defects, infants who are small for gestational age, and miscarriage. Researchers also found higher rates of infertility and spontaneous miscarriages among female hairdressers than women in any other occupation. In addition, the American Journal of Epidemiology concluded that hair stylists had triple the risk of developing breast cancer when they worked with hair dye for over five years. Other research on nail technicians has described adverse respiratory, neurological, and musculoskeletal effects for the technicians themselves.

In the U.S., the National Institute for Occupational Health and Safety (NIOSH) recently analyzed data from the National Birth Defects Prevention Study (NBDPS), a large multicenter, population-based case-control study of birth defects. Scientists looked to see if people working as nail technicians experienced higher rates of birth defects in their babies. They reported in June 2021 that mothers who gave birth to infants with a congenital heart defect (including any heart defect, conotruncal defects, right ventricular outflow tract obstruction, and septal defects) were roughly three times more likely to have worked as a nail technician during early pregnancy than mothers of infants with no birth defect. These same researchers also found that mothers who gave birth to infants with cleft lip or cleft palate were twice as likely to have worked as a hairdresser during early pregnancy as mothers of infants with no birth defect. They observed similar connections in mothers working as hairdressers who had infants born with defects of the ear (anotia and microtia) and abdominal wall (gastroschisis).

Most of the research and data available on the occupational hazards of the beauty industry are observational – meaning that there is only a correlation or association observed between hairdressers and nail techs and birth defects, miscarriage, and infertility. There is no direct proof that certain chemicals cause these adverse birth outcomes. Unfortunately, it is nearly impossible to get this kind of scientific proof – it is unethical to knowingly and purposely expose pregnant women to potentially-harmful chemicals in the name of science.

Beyond observations of associations, there is something called biological plausibility for the argument that exposure to toxic beauty chemicals puts pregnant people and their children at risk. Biological plausibility means that scientists can explain how chemicals could cause the increased risk, demonstrating a cause-and-effect relationship between exposure to nail salon chemicals and harm to pregnant women and their babies.

The chemicals found in common salon products can cause adverse effects on the hypothalamic-pituitary-ovarian axis – at least in studies of rats. The hypothalamic-pituitary-ovarian axis is a fancy word for the hormonal communication system between two glands in your brain (the hypothalamus and pituitary) and your ovaries.

The other pregnancy health risk for hair stylists or nail technicians is the nature of their jobs. They have to spend long hours, hard at work on their feet, working in unusual positions, in restricted postures, or doing repetitive work. Joint pain, injury, and chronic overuse injuries are nothing new for those working in the beauty industry, but the risk for injury increases during pregnancy.

Pregnancy hormones relax joints, the pregnant belly changes your center of gravity, and back, spine, and joint pain are regular occurrences for all pregnant women. Aside from back injury, nail techs and hair stylists are at greater risk for carpal tunnel syndrome during pregnancy. Other industries are required under the U.S. Department of Labor’s Occupational and Safety Hazards Administration (OSHA) regulations to make accommodations for pregnant people to protect them from injury. Still, many smaller, independently-owned salons are not as closely regulated.

So, how can you keep yourself and your baby safe if you are a nail technician or hairdresser? Know your rights. In some parts of the U.S., nail technicians, aided by labor organizers, want to create a new council comprised of government officials, workers, and salon owners to decide healthier wages and labor standards. You can talk to your employer for better ventilation, more breaks, and accommodations for your changing body to avoid muscle strains or back injuries.

And what about getting manicures and pedicures, your hair dyed, or other beauty treatments during pregnancy? In general, your exposure to harmful chemicals will be much lower than it is for pregnant people working forty-plus-hour work weeks for their entire pregnancy. Nevertheless, some pregnant people go less often to salons, find salons that use chemical-free products, or hold off on acrylic nails or keratin-straightening treatments until after their delivery. If you continue dyeing your hair during pregnancy, look for a professional ammonia-free hair color with the least amount of p-phenylenediamine (PPD) and other types of pigment.

However, remember that many of these harmful chemicals can build up in your body over time. If your future might involve a pregnancy, you may want to make changes sooner rather than later. Look for well-ventilated salons, use more natural products and treatments, and weigh which beauty treatments are worth the potential harm to your future offspring. Remember your power as a consumer as well. By giving your business to salons that use safer products, are well-ventilated, and pay their stylists and technicians more than minimum wage, you send a message to salon owners about changes needed for a more sustainable and healthier beauty industry.

Amy Harris
Amy Harris is a certified nurse-midwife with a Master's Degree in Maternal and Child Health from Harvard Chan School of Public Health. Her passions are health literacy and women's reproductive health. A recent two-year sabbatical with her family in Spain was the impetus for becoming a freelance women's health writer. An exercise nut, she is happiest outdoors and on adventures abroad.

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