Are topical corticosteroids (steroids) safe to use during early pregnancy?

From the Guidelines

Topical steroids can be safely used during early pregnancy when used as directed, according to the most recent and highest quality study available 1. The use of topical steroids in pregnancy is supported by guidelines that suggest their safety when used appropriately [ 1 ]. Key considerations for the use of topical steroids during pregnancy include:

• Using low to moderate potency topical steroids like hydrocortisone, triamcinolone, or desonide [ 1 ]
• Applying them sparingly to affected areas, using the minimum effective amount for the shortest duration necessary to control symptoms [ 1 ]
• Avoiding very high potency steroids like clobetasol propionate unless absolutely necessary [ 1 ]
• Limiting application to small body surface areas to minimize systemic absorption [ 1 ]
• Informing healthcare providers about pregnancy before using any medication, including topical steroids, to determine the most appropriate treatment and minimize potential risks [ 1 ]. It is essential to weigh the benefits and risks of using topical steroids during pregnancy, considering the potential for minimal systemic absorption when used appropriately, especially with lower potency formulations [ 1 ]. However, extensive use of high-potency steroids over large body areas could potentially increase systemic absorption, and alternative treatments should be considered when possible [ 1 ]. Always consult with a healthcare provider before using topical steroids during pregnancy to ensure the safest and most effective treatment approach [ 1 ].

From the FDA Drug Label

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 There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids. Therefore, topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

The use of topical steroids in early pregnancy is not entirely safe and should be used with caution. Key considerations include:

• The potential risk of teratogenic effects to the fetus
• The lack of adequate and well-controlled studies in pregnant women
• The need to weigh the potential benefits against the potential risks to the fetus Based on the information provided, it is recommended that topical corticosteroids should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus 2.

From the Research

Safety of Topical Steroids in Early Pregnancy

• The use of topical steroids in early pregnancy has been studied in several research papers, including 3, 4, 5, 6, and 7.
• According to 3, most 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.
• However, 3 and 7 suggest that maternal use of potent to very potent topical corticosteroids, especially when the cumulative dosage is very large, may be associated with low birth weight.
• 4 states that topical corticosteroids can work safely and effectively in patients who are pregnant or lactating, and 5 notes that topical drugs have little systemic absorption, making them safer than oral or parenteral agents.
• 6 confirms that the available evidence found no associations of maternal use of topical corticosteroids of any potency with mode of delivery, birth defects, preterm delivery, fetal death, and low Apgar score, but highlights the potential risk of low birth weight with potent to very potent topical corticosteroids.

Key Findings

• No significant associations between topical corticosteroids and congenital abnormality, preterm delivery, or stillbirth were found in most studies 3, 7.
• Maternal use of mild to moderate potency topical steroids may be associated with a decreased risk of fetal death 3.
• The quality of evidence is generally low, and further cohort studies with comprehensive outcome measures are needed to fully assess the safety of topical corticosteroids in pregnancy 3, 7.