title: Intranasal triamcinolone use during pregnancy and the risk of adverse pregnancy outcomes.
abstract: Intranasal corticosteroid use during pregnancy has increased over the past decade.
  
  
  
  We aim to estimate the safety of intranasal triamcinolone use during pregnancy, which was introduced for over-the-counter use in October 2013.
  
  
  
  We designed a population-based prospective cohort study. From a cohort of 289,723 pregnancies in Montreal, Quebec, Canada, from 1998-2008, intranasal triamcinolone-exposed, other intranasal corticosteroid-exposed, and nonexposed women during the first trimester were studied for major congenital malformations (overall and organ specific) and spontaneous abortions and during the second/third trimesters for small-for-gestational age (SGA) newborns. The first trimester is the time window of interest for malformations and spontaneous abortion (organogenesis), and the second/third trimesters are the time windows of interest for SGA (fetal growth). Logistic regression model-based generalized estimating equations were used.
  
  
  
  Adjusting for potential confounders, use of intranasal triamcinolone during the first trimester of pregnancy was not significantly associated with the risk of overall congenital malformations (odds ratio [OR], 0.88; 95% CI, 0.60-1.28; 31 exposed cases) compared with nonexposure; however, it was associated with the risk of respiratory defects (OR, 2.71; 95% CI, 1.11-6.64; 5 exposed cases). Pregnancy exposure to intranasal triamcinolone was not significantly associated with the risk of spontaneous abortion (OR, 1.04; 95% CI, 0.76-1.43; 50 exposed cases). No association was found between second- or third-trimester exposure to intranasal triamcinolone and the risk of SGA (OR, 1.06; 95% CI, 0.79-1.43; 50 exposed cases).
  
  
  
  Maternal exposure to intranasal triamcinolone during pregnancy was not associated with the risk of SGA/spontaneous abortions/overall malformations. However, it has been shown to increase the risk of respiratory system defects. Chance finding cannot be ruled out.
authors.affiliation: Research Center, CHU Ste-Justine, Montreal, Quebec, Canada; Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada. Electronic address: anick.berard@umontreal.ca.
authors.forename: Anick
authors.initials: A
authors.lastname: Bérard
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Odile
authors.initials: O
authors.lastname: Sheehy
authors.affiliation: Sanofi, R&D, Global Pharmacovigilance and Epidemiology, Paris, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Kurzinger
authors.affiliation: Sanofi, R&D, Global Pharmacovigilance and Epidemiology, Bridgewater, NJ.
authors.forename: Juhaeri
authors.initials: J
authors.lastname: Juhaeri
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology; D000281:Administration, Intranasal; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007236:Infant, Small for Gestational Age; D008137:Longitudinal Studies; D018811:Maternal Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D062486:Public Health Surveillance; D012307:Risk Factors; D014221:Triamcinolone / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014221:Triamcinolone
keywords: Triamcinolone; major congenital malformations; pregnancy; rhinitis; small for gestational age; spontaneous abortions