USE OF TOPICAL CORTICOSTEROIDS IN PREGNANCY

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(Date of issue: December 2016, Version: 1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

Corticosteroids are a class of hormones produced in the adrenal cortex which are involved in a range of physiological functions. Topical corticosteroids are commonly used to reduce inflammation and suppress the immune system in the treatment of atopic and auto-immune skin conditions. Topical corticosteroids available in the UK include: hydrocortisone, alclometasone, beclometasone, clobetasone, diflucortolone, fludroxycortide, fluocinolone, fluocinonide, fluocortolone, fluticasone, mometasone and triamcinolone.

Systemic exposure to corticosteroids in pregnancy has been associated in some but not all studies, with increased rates of orofacial clefts in the infant. However, it is unclear how this may relate to topical use of corticosteroids during pregnancy. As a general principle, topical exposure to most drugs is thought to pose a low risk to the developing fetus. However, when assessing any possible risk, factors which influence the amount of drug that will be absorbed into the bloodstream, such as the surface area of the skin to which it will be applied, the frequency of application, the condition of the skin (i.e. broken or unbroken), and in the case of corticosteroids, the potency of the preparation, should be borne in mind. If topical use is considered extensive, or significant systemic absorption is expected, data on systemic use of steroids in pregnancy (see separate monograph) may provide a relevant evidence base when considering the risk of fetal effects.

The majority of the available studies do not indicate that use of topical corticosteroids in early pregnancy causes orofacial clefts in the offspring. However, since some data are conflicting, further statistically robust studies that preferably stratify analyses by potency are required to absolutely rule out an increased risk. The available data on other specific malformations are too limited to permit an evidence-based assessment of risk, and further research is therefore required. Overall, the available data do not suggest that gestational exposure to topical corticosteroids of any potency increases the risk of preterm delivery or low birth weight in the infant, although a possible effect of large cumulative doses on birth weight remains to be confirmed or refuted with further research. Due to limited data it is not currently possible to conduct an evidence-based assessment of the risks of spontaneous abortion or adverse neurodevelopmental outcomes in the child following gestational exposure to topical corticosteroids.

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.     
                 
This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.