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Original Investigation
May 5, 2021

Evaluation of Topical Corticosteroid Use in Pregnancy and Risk of Newborns Being Small for Gestational Age and Having Low Birth Weight

Author Affiliations
  • 1Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
  • 2Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
  • 3Department of Allergy and Dermatology, Gentofte and Herlev Hospital, Copenhagen, Denmark
  • 4Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
JAMA Dermatol. 2021;157(7):788-795. doi:10.1001/jamadermatol.2021.1090
Key Points

Question  Does topical corticosteroid use in pregnancy increase the risks of the newborn being small for gestational age or having low birth weight?

Findings  This cohort study of 1.1 million pregnancies included all 60 498 pregnancies (60 497 matched) exposed to topical corticosteroids in Denmark from 1997 through 2016. No association was found between topical corticosteroid use during pregnancy and increased risks of newborns being small for gestational age or having low birth weight, regardless of corticosteroid potency and amount used.

Meaning  These findings suggest that a moderate to large increase in the risk of newborns being small for gestational age or having low birth weight with corticosteroid use in pregnancy is unlikely, even when large amounts of potent to very potent topical corticosteroids are used.

Abstract

Importance  Topical corticosteroids are frequently used during pregnancy. Limited data have raised concerns about an increased risk of the newborn being small for gestational age (SGA) and having low birth weight, in particular with use of potent to very potent agents during pregnancy.

Objective  To evaluate whether topical corticosteroid use in pregnancy is associated with increased risks of SGA and low birth weight.

Design, Setting, and Participants  From a source cohort of 1.1 million pregnancies with individual-level informed data from various registries, this nationwide cohort study identified topical corticosteroid–exposed pregnancies in Denmark from January 1, 1997, to December 31, 2016, for a total of 60 497, that were matched with 241 986 unexposed pregnancies on the basis of propensity scores, including a wide set of baseline characteristics. Data analysis was performed from September 8, 2020, to February 23, 2021.

Exposures  Filled prescriptions for topical corticosteroids during pregnancy.

Main Outcomes and Measures  Primary outcomes were SGA and low birth weight. Association between outcomes and exposure was assessed by relative risk ratios (RRs) and absolute risk differences (ARDs).

Results  Among the 60 497 matched pregnancies exposed to topical corticosteroids, 5678 (9.4%) of the delivered infants were born SGA compared with 22 634 infants (9.4%) among the matched unexposed pregnancies (RR, 1.00; 95% CI, 0.98-1.03 and ARD, 0.3; 95% CI, −2.3 to 2.9 per 1000 pregnancies). Low birth weight occurred in 2006 (3.3%) of the exposed pregnancies compared with 8675 (3.6%) of the unexposed pregnancies (RR, 0.92; 95% CI, 0.88-0.97 and ARD, −2.7; 95% CI, −4.3 to −1.1 per 1000 pregnancies). Exposure to potent to very potent topical corticosteroids at any amount was not associated with an increased risk of SGA (RR, 1.03; 95% CI, 0.99-1.07) or low birth weight (RR, 0.94; 95% CI, 0.88-1.00). Post hoc analyses did not find a significant increased risk among those receiving large amounts of potent to very potent topical corticosteroids (ie, >200 g throughout pregnancy) compared with unexposed pregnancies (RR, 1.17; 95% CI, 0.95-1.46 for SGA and RR 1.14; 95% CI, 0.81-1.60 for low birth weight).

Conclusions and Relevance  This large cohort study found no association between topical corticosteroid use in pregnancy and an increased risk of SGA or low birth weight. These results suggest that a moderate to large increase in the risk is unlikely, even when large amounts of potent to very potent topical corticosteroids are used in pregnancy.

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