Pregnancy Outcomes After Maternal Exposure to Topical Corticosteroids: A UK Population-Based Cohort Study | Congenital Defects | JAMA Dermatology | JAMA Network
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Original Investigation
November 2013

Pregnancy Outcomes After Maternal Exposure to Topical Corticosteroids: A UK Population-Based Cohort Study

Author Affiliations
  • 1Department of Dermatology and Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan
  • 2Department of Dermatology, Far Eastern Memorial Hospital and Oriental Institute of Technology, New Taipei, Taiwan
  • 3Department of Primary Health Care Sciences, University of Oxford, Oxford, England
  • 4Nuffield Department of Clinical Medicine, University of Oxford, Oxford, England
JAMA Dermatol. 2013;149(11):1274-1280. doi:10.1001/jamadermatol.2013.5768
Abstract

Importance  Topical corticosteroids are indicated for pregnant women with skin conditions, but their safety in pregnancy is not fully understood.

Objective  To investigate whether maternal exposure to topical corticosteroids results in adverse pregnancy outcomes.

Design  Retrospective cohort study.

Setting  United Kingdom National Health Service.

Participants  A total of 2658 pregnant women exposed to topical corticosteroid and 7246 unexposed pregnant women.

Exposure  Topical corticosteroids dispensed during pregnancy.

Main Outcomes and Measures  Orofacial cleft, low birth weight, preterm delivery, fetal death, low Apgar score, and mode of delivery.

Results  No associations of maternal topical corticosteroid exposure with orofacial cleft, low birth weight, preterm delivery, fetal death, low Apgar score, and mode of delivery were found in the primary analysis (adjusted risk ratio [RR], 1.85 [95% CI, 0.22-15.20] [P = .57]; 0.97 [95% CI, 0.78-1.19] [P = .75]; 1.20 [95% CI, 0.73-1.96] [P = .48]; 1.07 [95% CI, 0.56-2.05] [P = .84]; 0.84 [95% CI, 0.54-1.31] [P = .45]; and P = .76, respectively). Stratified analyses based on potency did not reveal any significant associations in most of these categories either, but an exploratory analysis showed a significantly increased risk of low birth weight when the dispensed amount of potent or very potent topical corticosteroids exceeded 300 g during the entire pregnancy (adjusted RR, 7.74 [95% CI, 1.49-40.11]; P = .02).

Conclusions and Relevance  This study reassuringly showed no associations of maternal topical corticosteroid exposure with orofacial cleft, preterm delivery, fetal death, low Apgar score, and mode of delivery. With this study and all available evidence taken together, the risk of low birth weight seems to correlate with the quantity of topical corticosteroid exposure.

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