USE OF TOPICAL CORTICOSTEROIDS IN PREGNANCY

Topical corticosteroids reduce inflammation and suppress the immune system in the treatment of atopic and auto-immune conditions affecting the skin, eyes and nasal mucosa. Topical corticosteroids available in the UK include hydrocortisone, alclometasone, beclometasone, clobetasone, diflucortolone, fludroxycortide, fluocinolone, fluocinonide, fluocortolone, fluticasone, mometasone and triamcinolone.

Appropriate use of topical corticosteroids should, in general, not lead to high systemic levels and is therefore unlikely to pose significant risks during pregnancy. However, a number of factors can lead to increased exposure levels, such as use of higher potency preparations, use on broken skin or large areas of skin, use for prolonged periods, and use outside of the manufacturer’s instructions (particularly regarding frequency and quantity of application). This should be borne in mind when carrying out risk assessments.

Systemic exposure to corticosteroids in pregnancy has been associated in some, but not all studies, with increased rates of orofacial clefts in the infant. Overall, the available data do not demonstrate that use of topical corticosteroids in pregnancy increases the risk of congenital malformation, including orofacial clefts, although information on some specific malformations is limited.

Data do not demonstrate that use of topical corticosteroids as a group in pregnancy is associated with miscarriage, intrauterine death, preterm delivery, or reduced fetal growth. However, where data have been stratified by exposure type, there is a suggestion of an increased risk of lower birth weight with use of high potency preparations or large cumulative doses. Ongoing research is required to confirm these findings and to clarify whether higher potency preparations or large cumulative doses may also pose increased risks of other adverse fetal outcomes.

If the use of topical corticosteroids is indicated at any stage of pregnancy, treatment should not be withheld. Exposure to topical corticosteroids at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.