Safety of topical steroids in pregnancy

Chi C-C, Lee C-W, Wojnarowska F, Kirtschig G

Published Online:

December 8, 2010

Topical steroids are the most commonly used medicines for skin conditions. Pregnant women may need topical steroids to treat skin conditions but it is unclear if they are safe or harmful during pregnancy. This review shows that there are limited data on the impact of mothers' use of topical steroids, and could not find a relation with birth defect, preterm delivery, or stillbirth. Use of large amounts of very potent topical steroids has been related to low birthweight. However, the current evidence is conflicting and inconclusive, but the major concern is that the use of very potent topical steroids might cause small babies.

Abstract (click to read)

Background:

Topical corticosteroids are the most frequently prescribed dermatological treatment and are frequently used by pregnant women with skin conditions. However, little is known about their safety in pregnancy.

Objectives:

To assess the effects of topical corticosteroids on pregnancy outcomes.

Search strategy:

On 5th May 2009 we searched the Cochrane Skin Group Specialised Register, the Cochrane Pregnancy and Childbirth Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (from 2003), and EMBASE (from 2005). We searched LILACS, CINAHL, British Nursing Index, SCI-EXPANDED, BIOSIS Previews, Conference Papers Index, and Conference Proceedings Citation Index-Science from inception to May 2009. We scanned the bibliographies of the included studies, published reviews, and articles that had cited the included studies. Pharmaceutical companies that have introduced an original topical corticosteroid product were contacted.

Selection criteria:

Randomised controlled trials and cohort studies of topical corticosteroids in pregnant women, and case-control studies comparing maternal exposure to topical corticosteroids between cases and controls were included where outcomes were those we had pre-specified. Outcomes included mode of delivery, congenital abnormality, birthweight, preterm delivery, stillbirth, and low Apgar score.

Data collection and analysis:

Two authors independently applied selection criteria, extracted data, and assessed the quality of the included studies. A third author was available for resolving differences of opinion.

Main results:

Seven studies, including 2 cohort and 5 case-control studies, of 659,675 participants were included. We did not undertake a meta-analysis due to considerable methodological heterogeneity. The available data was limited and mainly on orofacial cleft. Most studies did not find significant associations between topical corticosteroids and pregnancy outcomes including mode of delivery, congenital abnormality, preterm delivery, and stillbirth. One study found a significant association between first trimester topical corticosteroid use and orofacial cleft, and another found a significant association between very potent topical corticosteroids and low birthweight. Nevertheless, all the studies had drawbacks, and the quality of evidence was low to very low.

Authors' conclusions:

Currently limited and inconclusive data are unable to detect an association between topical corticosteroids and congenital abnormality, preterm delivery, or stillbirth. The current evidence shows no statistically significant difference between pregnant women who use and those who do not use topical corticosteroids. However, there does appear to be an association of very potent topical corticosteroids with low birthweight. Cohort studies with comprehensive outcome measures, assessment of effects of corticosteroid potency and dose, application methods, and reasons for giving them, and a very large sample size are needed.

This record should be cited as:

Chi C-C, Lee C-W, Wojnarowska F, Kirtschig G. Safety of topical corticosteroids in pregnancy. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007346. DOI: 10.1002/14651858.CD007346.pub2

Assessed as up to date:

May 5, 2009

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Primary Review Group:

Skin Group

Health topics:

Pregnancy & childbirth > Medical problems during pregnancy > Other

Pregnancy & childbirth > Symptoms during pregnancy

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Independent high-quality evidence for health care decision making

Safety of topical steroids in pregnancy

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