Topical Corticosteroids and Pregnancy

Posted on 23rd December 2021 by Tessa Li Chyin Lim

In this blog post, I will provide my own summary of a 2015 Cochrane systematic review: “Safety of topical corticosteroids in pregnancy“. 

Introduction

Topical corticosteroids have anti-inflammatory and immunosuppressive effects on dermatological conditions. Topical corticosteroids come in different forms such as gels, lotions and creams. Different corticosteroids also have different potencies. High-potency topical corticosteroids can suppress the hypothalamic-pituitary axis (1).

Adverse effects of topical corticosteroids

According to UpToDate, some of the common side effects of topical corticosteroids include atrophy, telangiectasia, striae, acneiform eruption, withdrawal syndrome, allergic sensitization, hypertrichosis, purpura and changes in pigmentation. It also remains unknown whether topical corticosteroids are secreted in breast milk. However, there are no side effects found in lactating women (1).

Topical corticosteroids

This Cochrane meta-analysis has involved 14 studies. These studies include case control studies with pre-specified outcomes, as well as cohort studies related to the usage of topical corticosteroids during pregnancy. The main outcomes are the mode of delivery, birth weight, preterm delivery (<37 weeks of gestation) and major congenital abnormality. Other outcomes are minor congenital abnormality, foetal death and a low Apgar score (<7 at the 5th minute).

It was found that there are no causal associations between the exposure of topical corticosteroids of all potencies during pregnancy and pregnancy outcomes. Examples of adverse pregnancy outcomes include preterm delivery and congenital abnormalities such as hypospadias and orofacial clefts. However, the quality of evidence is low. On the other hand, there might be a probable association between low birth weight and usage of potent or very potent corticosteroids during pregnancy. This is shown in one cohort study where the corticosteroids usage exceeded 300g (RR 7.7, 95% CI 1.5-40.1, low quality evidence).

The heterogeneity of the studies was assessed using the I² statistic. Meta-analysis techniques were applied when I² statistic was below 80%. The reporting biases were assessed separately using different designs. A funnel plot would be used to test publication bias when the data is adequate.

Clinical Practice and Future Research

Further evaluations and investigations would be valuable guidance for future clinical practice.

You can read the Plain Language Summary and see more details of the review under the Cochrane Clinical Answer ‘What adverse events are associated with use of topical corticosteroids in pregnancy?’

References

1. Goldstein BG, Goldstein AO. Topical corticosteroids: Use and adverse effects [Internet]. UpToDate; February 2020 [cited 2020 Jul 11]
2. Chi CC, Wang SH, Wojnarowska F, Kirtschig G, Davies E, Bennett C. Safety of topical corticosteroids in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD007346. DOI: 10.1002/14651858.CD007346.pub3.

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