Is topical hydrocortisone safe for pregnant women?

From the Guidelines

Topical hydrocortisone is generally considered safe for pregnant women when used as directed, with low-potency formulations preferred to minimize systemic absorption. The use of topical corticosteroids during pregnancy has been studied, and most studies have shown no significant increase in congenital malformations or premature birth in children of women treated with these medications 1. However, some studies suggest a relationship between topical corticosteroids and intra-uterine growth restriction (IUGR) 1. When using topical hydrocortisone during pregnancy, it is essential to:

• Apply a thin layer only to affected areas
• Avoid covering large body surfaces
• Use for the shortest duration necessary to control symptoms
• Choose low-potency formulations, such as hydrocortisone 1% or 2.5%, which have minimal absorption through the skin 1. Prolonged use of high-potency corticosteroids over large areas could potentially increase systemic absorption and theoretically affect the developing fetus. Therefore, if you're pregnant and need to use topical hydrocortisone for more than a few days or on larger areas, consult with your healthcare provider first to ensure the benefits outweigh any potential risks for your specific situation 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. Drugs of this class should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time

The use of topical hydrocortisone in pregnant women is not directly addressed in the provided drug labels, which discuss betamethasone. However, based on the information about corticosteroids in general, topical corticosteroids should be used with caution. The decision to use topical hydrocortisone during pregnancy should be made on a case-by-case basis, considering the potential benefits and risks, and only if the potential benefit justifies the potential risk to the fetus 2 2. Key considerations include:

• Potential teratogenic effects in laboratory animals
• Lack of adequate and well-controlled studies in pregnant women
• Need for cautious use to minimize potential risks to the fetus It is essential to consult a healthcare provider to determine the safest course of treatment.

From the Research

Safety of Topical Hydrocortisone in Pregnancy

• The safety of topical hydrocortisone in pregnant women has been studied in several research papers 3, 4, 5, 6, 7.
• According to a population-based cohort study, maternal exposure to topical corticosteroids, including hydrocortisone, does not appear to increase the risk of orofacial cleft, preterm delivery, or fetal death 3.
• However, the use of potent/very potent topical corticosteroids during pregnancy has been associated with an increased risk of fetal growth restriction 3, 4.
• A systematic review of the safety of topical corticosteroids in pregnancy found that the available data were limited and mainly focused on orofacial cleft, but suggested that very potent topical corticosteroids may be associated with low birthweight 5.
• A preliminary trial comparing topical hydrocortisone cream with a mechanical treatment for symptomatic hemorrhoids in pregnancy found that both treatments improved symptoms, but the mechanical treatment was more effective in reducing pain, swelling, and discomfort 6.
• In general, pregnant women can be reassured that there is no apparent increased risk of adverse fetal effects when using topical corticosteroids during pregnancy, although the lowest potency required should be prescribed whenever possible 7.

Key Findings

• No increased risk of orofacial cleft, preterm delivery, or fetal death with topical corticosteroid use 3.
• Increased risk of fetal growth restriction with potent/very potent topical corticosteroids 3, 4.
• Very potent topical corticosteroids may be associated with low birthweight 5.
• Topical hydrocortisone cream can improve symptoms of hemorrhoids in pregnancy, but may not be as effective as mechanical treatments 6.
• Pregnant women should be prescribed the lowest potency topical corticosteroid required whenever possible 7.