Topical Steroids and Adverse Pregnancy Outcomes

The use of topical corticosteroids by pregnant women was not associated with mode of delivery or with any increased risk of orofacial cleft, preterm delivery, fetal death, and low Apgar score, according to the results of a study published online in JAMA Dermatology.

“Topical steroids are the most frequently used dermatologic medication,” said study author Ching-Chi Chi, MD, MMS, of the Chang Gung University College of Medicine, Taiwan. “This study aimed to obtain a better understanding of the safety of topical steroid use in pregnancy, which is important to both pregnant women and physicians.”

Chi and colleagues conducted a retrospective cohort study of 2658 pregnant women exposed to topical corticosteroids in the United Kingdom National Health Service from 1989 to 2006. Women were aged 15 to 44 years and had received at least 1 prescription for topical corticosteroids. Outcomes related to several pregnancy outcomes were compared against 7246 unexposed pregnant women.

“This study reassured the lack of associations of maternal use of topical steroid with orofacial cleft, preterm delivery, fetal death, low Apgar score, and mode of delivery,” Chi said.

However, when the researchers conducted an exploratory analysis, the results showed an almost 8-fold increased risk of low birth weight when the dispensed amount of corticosteroids was 300 grams or more (adjusted risk ratio=7.74; 95% CI, 1.49-40.11).

“Taking this study and all available evidence together, the risk of low birth weight appears to correlate with the quantity of topical corticosteroid exposure,” Chi told ObGyn.net.

According to the researchers, mild or moderate topical corticosteroids are still the preferred treatment if indicated in pregnant women with a skin condition. However, when potent or very potent topical corticosteroids are needed, physicians should limit the amounts used and monitor fetal growth.

Pertinent Points:
- Corticosteroid use during pregnancy was not associated with orofacial cleft, preterm delivery, fetal death, low Apgar score, and mode of delivery.
- The use of 300 grams or more of corticosteroid during pregnancy was linked to an increased risk for low birth weight.

References:

Chi CC, Wang SH, Mayon-White R, Wojnarowska F. Pregnancy outcomes after maternal exposure to topical corticosteroids: a UK population-based cohort study. JAMA Dermatol. 2013 Sep 4. doi: 10.1001/jamadermatol.2013.5768. [Epub ahead of print]