Is topical corticosteroid (steroid) cream safe during pregnancy?

From the Guidelines

Topical steroid creams are generally considered safe to use during pregnancy when used as directed, with low to moderate potency options like hydrocortisone, triamcinolone, or mometasone being preferred. According to the most recent evidence from the European Respiratory Journal 1, these medications have minimal systemic absorption when used appropriately, meaning very little medication enters the bloodstream to reach the developing baby.

Key Considerations

• Low to moderate potency steroid creams are preferred options for treating skin conditions during pregnancy
• These medications should be applied sparingly to affected areas, using the minimum effective amount for the shortest duration necessary to control symptoms
• It's best to avoid applying high-potency steroid creams over large body areas or for extended periods, as this theoretically increases systemic absorption
• When using steroid creams during pregnancy, apply a thin layer to affected areas once or twice daily as directed by your healthcare provider, and wash hands thoroughly after application

Safety Profile

The safety profile of topical steroids in pregnancy is reassuring, with most studies showing no significant increase in congenital malformations or premature birth in children of women treated with topical corticosteroids during pregnancy 1. However, some studies suggest a relationship between topical corticosteroids and intra-uterine growth restriction (IUGR) 1.

Recommendations

• Always consult with your healthcare provider before using any medication during pregnancy, as they can recommend the most appropriate treatment based on your specific condition and pregnancy status
• Follow the recommended dosage and application guidelines to minimize potential risks
• Monitor your condition closely and report any changes or concerns to your healthcare provider promptly

From the FDA Drug Label

Corticosteroids have been shown to be teratogenic in laboratory animals when administered systemically at relatively low dosage levels. Some corticosteroids have been shown to be teratogenic after dermal application to laboratory animals Clobetasol propionate has not been tested for teratogenicity when applied topically; however, it is absorbed percutaneously, and when administered subcutaneously it was a significant teratogen in both the rabbit and mouse. Clobetasol propionate topical solution should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals Therefore, topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Steroid cream use in pregnancy should be approached with caution.

• The potential benefits of using steroid creams, such as clobetasol propionate 2 and triamcinolone 3, during pregnancy must be weighed against the potential risks to the fetus.
• These creams have been shown to be teratogenic in laboratory animals, especially when administered systemically or in large amounts.
• There are no adequate and well-controlled studies in pregnant women on the teratogenic effects of topically applied corticosteroids.
• As a result, steroid creams should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.

From the Research

Steroid Cream in Pregnancy

• The use of topical corticosteroids in pregnancy is a common practice for treating inflammatory skin conditions such as psoriasis and atopic dermatitis 4.
• Studies have shown that topical corticosteroids can be used safely and effectively in patients who are pregnant or lactating, with no significant increase in adverse effects 4, 5.
• A systematic review of 14 studies, including 5 cohort and 9 case-control studies, found no causal associations between maternal exposure to topical corticosteroids of any potency and pregnancy outcomes, including mode of delivery, congenital abnormalities, preterm delivery, fetal death, and low Apgar score 5.
• However, the review did find a possible association between low birth weight and maternal use of potent to very potent topical corticosteroids, especially when the cumulative dosage of topical corticosteroids throughout the pregnancy is very large 5.
• Another study found that mild to moderate potency topical corticosteroids may have a protective effect on fetal death, but this finding requires further investigation 5.

Safety Precautions

• When prescribing topical corticosteroids for use in pregnant women, lower potencies and shorter durations should be used to minimize the risk of adverse effects 4.
• The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 4.
• Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 4.

Types of Topical Corticosteroids

• There are several types of topical corticosteroids available, including hydrocortisone, prednisone, triamcinolone, and dexamethasone 6.
• Each type of corticosteroid has its own effects and side effects, and the choice of corticosteroid will depend on the specific condition being treated and the individual patient's needs 6, 7.
• Topical administration of corticosteroids, including oral inhalation, is often used to avoid the significant adverse effects associated with chronic use 7.