Systematic review of the safety of topical corticosteroids in pregnancy.
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.


CONCLUSIONS
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.
Chi
Ching-Chi
CC
Department of Dermatology, Chang Gung Memorial Hospital-Chiayi, Chiayi, Taiwan.
Wang
Shu-Hui
SH
Kirtschig
Gudula
G
Wojnarowska
Fenella
F
D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D005260:Female; D005315:Fetal Diseases / Q000139:chemically induced; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D012449:Safety; D012871:Skin Diseases / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones