Safety of topical corticosteroids in pregnancy.
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.


OBJECTIVE
To assess the effects of topical corticosteroids on pregnancy outcomes.


METHODS
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.


METHODS
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.


METHODS
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.


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.


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.
Chi
Ching-Chi
CC
Department of Dermatology, Chang Gung Memorial Hospital-Chiayi, Chang Gung University College of Medicine, 6, Sec West, Chia-Pu Road, Putz, Chiayi, Taiwan, 61363.
Lee
Chia-Wen
CW
Wojnarowska
Fenella
F
Kirtschig
Gudula
G
D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D001724:Birth Weight / Q000187:drug effects; D016022:Case-Control Studies; D002971:Cleft Lip / Q000139:chemically induced; D002972:Cleft Palate / Q000139:chemically induced; D015331:Cohort Studies; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D047928:Premature Birth / Q000139:chemically induced; D012880:Skin Pigmentation
D000305:Adrenal Cortex Hormones; D003879:Dermatologic Agents