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Risks of Topical Corticosteroid Use in Pregnant Women

A recent report examined the use of topical corticosteroids on pregnant women. Topical corticosteroids are commonly prescribed for atopic dermatitis, rash, and eczema, yet the US Food and Drug Administration (FDA) labels topical corticosteroids as pregnancy risk category C, meaning that animal studies have shown adverse fetal effects, but there are no adequate and well-controlled studies in pregnant women. Despite the unknown effects topical corticosteroids are prescribed to more than 6% of pregnant women.

Researchers examined medical records in the United Kingdom’s Health Informatics Centre data sets from 1989 to 2006 and looked at the link between pregnant women, aged 15 to 44 years, who had been prescribed topical corticosteroids and birth outcomes of low birth weight (LBW), orofacial cleft, preterm delivery, fetal death, low Apgar score, and mode of delivery (vaginal or cesarean). 

Medical records for 9905 women were examined. Out of this number 2658 pregnant women had been exposed to topical corticosteroid and 7246 were unexposed. Pregnant women who had received prescriptions for other forms of corticosteroids (nasal, injection, inhalation, or systemic) and women who were pregnant with multiples or who had received reproductive assistance were excluded. 

Researchers state that their analysis of the data reassuringly showed no associations of maternal topical corticosteroid exposure with LBW, orofacial cleft, or other risks. Researchers did note that they saw a very low correlation between the prescription of strong topical corticosteroids during the first trimester and orofacial cleft, as the critical period for the fusion of the lip and palate is from the 5th to the 12th gestational week.  

For pregnant women with a skin condition, mild or moderate topical corticosteroids are the preferred treatments if indicated. When potent or very potent topical corticosteroids are needed, the amounts used should be kept to a minimum, and fetal growth should be monitored.

Source: JAMA Dermatol. Published online September 04, 2013. doi:10.1001

Image: Kingray

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