Potent topical steroids during pregnancy up risk of low birth weight

By Marilynn Larkin

NEW YORK (Reuters Health) - Although topical corticosteroids generally are safe during pregnancy, use of potent formulations is associated with low birth weight babies, researchers report.

"Pregnant women may have skin conditions that require topical corticosteroids treatment. However, the safety of topical corticosteroids in human pregnancy was largely unclear," Dr. Ching-Chi Chi of Chang Gung University College of Medicine in Chiayi, Taiwan, told Reuters Health by email.

"To understand whether maternal use of topical corticosteroids affects pregnancy outcomes, we conducted a systematic (Cochrane) review of available best evidence."

The review included five cohort and nine case-control studies. "Most studies found no causal associations between maternal use of topical corticosteroids and pregnancy outcomes, including assisted or cesarean delivery, birth defects, preterm delivery, fetal death, and low Apgar score," Dr. Chi and colleagues write in JAMA Dermatology, online June 29.

An analysis based on potency also found no associations of maternal use for any of those pregnancy outcomes. "However, the evidence does indicate an increased risk of low birth weight when mothers apply potent or very potent topical corticosteroids, but not in mothers who apply moderate or weak topical corticosteroids," Dr. Chi said.

Specifically, one study observed a dose-response relationship between maternal use of topical corticosteroids and low birth weight, whereas two studies found a significant association between maternal use of potent or very potent topical corticosteroids and low birth weight. Another study found an increased risk of low birth weight in those who received more than 300 g of potent or very potent topical corticosteroids throughout pregnancy, according to the authors.

By contrast, maternal use of mild or moderately potent topical corticosteroids was not associated with low birth weight.

Although maternal use of mild or moderately potent topical corticosteroids seemed to decrease the risk of fetal death (relative risk 0.70), the finding was not supported by a dose-response relationship, the authors noted. No similar effect was observed for women who used potent or very potent topical corticosteroids (RR 1.14).

"Physicians and pregnant women may use the evidence in making decisions on topical corticosteroid (use)," Dr. Chi concluded.

Dr. Teresa Hoffman, an obstetrician-gynecologist affiliated with Mercy Medical Center in Baltimore, told Reuters Health by phone, "Generally, I try to have patients use over-the-counter creams, which usually are not a risk. But if they buy a big tube and put it all over their body several times a day, that's different."

"For any medication, the least amount that can be effective is best," she continued. "I tell my patients they can apply an over-the-counter product to the affected area up to four or five times a day. But a prescription cream, which is more potent, should by applied only once or twice a day."

Dr. Hoffman added, "Women need to know that if they're pregnant, they should tell their ob-gyn about any cream they're using. Some creams, like wrinkle cream or acne cream, we don't recommend at all."

The authors reported no funding or conflicts of interest.

SOURCE: https://bit.ly/29r9hhu

JAMA Dermatol 2016.