Systematic review of the safety of topical corticosteroids in pregnancy
published online 01 February 2010.
Background
Pregnant women may have skin conditions that require topical corticosteroids. However, little is known about their safety in pregnancy.
Objective
We sought to evaluate the available evidence concerning the safety of topical corticosteroids in pregnancy.
Methods
We systematically searched 17 databases and trial registers, and contacted pharmaceutical companies. Randomized controlled trials and cohort studies of topical corticosteroids in pregnant women, and case-control studies comparing maternal exposure to topical corticosteroids between patients and control subjects were included. The Newcastle-Ottawa Scale was used for quality assessment of included studies.
Results
Seven studies, including two cohort and five case-control studies, were included. Most studies did not find significant associations of topical corticosteroids with congenital abnormality, preterm delivery stillbirth, and mode of delivery. One study found a significant association between first-trimester use of topical corticosteroids and orofacial cleft, and another study found a significant association between very potent topical corticosteroids and low birthweight.
Limitations
The available data were limited and mainly on orofacial cleft. The quality of evidence was generally low.
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. Further cohort studies with comprehensive outcome measures, consideration of corticosteroid potency, dosage and indications, and a large sample size are needed.
aDepartment of Dermatology at Chang Gung Memorial Hospital-Chiayi, Chiayi, Taiwan
bDepartment of Dermatology, Churchill Hospital, Oxford, United Kingdom
cDepartment of Dermatology, Cochrane Skin Group, United Kingdom
dDepartment of Dermatology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
Reprint requests: Shu-Hui Wang, MD, MS, Department of Dermatology, Buddhist Tzu Chi General Hospital, Taipei Branch, 289, Jianguo Rd, Sindian, Taipei 23142, Taiwan.
ABSTRACT