From the Guidelines
Topical hydrocortisone cream is generally considered safe to use during pregnancy when applied in small amounts for short periods of time. The use of topical corticosteroids, including hydrocortisone, 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 follow certain guidelines to minimize potential risks.
- Apply a thin layer to the affected area 1-2 times daily for up to 7 days.
- Avoid using it over large body areas or under occlusive dressings, as increased absorption could potentially affect the developing fetus.
- For persistent or severe skin conditions during pregnancy, it's best to consult with a healthcare provider before continuing use beyond a week.
The safety profile of topical hydrocortisone is based on the fact that when used topically in small amounts, very little of the medication enters the bloodstream 1. As with any medication during pregnancy, it is crucial to weigh the benefits and potential risks and consult with a healthcare provider if there are any concerns. In the case of topical hydrocortisone, the benefits of using the medication for short periods and in small amounts generally outweigh the potential risks, making it a viable option for managing pregnancy-related skin conditions like itching or mild rashes.
From the Research
Safety of Topical Hydrocortisone During Pregnancy
- The use of topical hydrocortisone cream during pregnancy has been studied in several research papers 2, 3, 4, 5, 6.
- According to a study published in the Canadian family physician Medecin de famille canadien, pregnant women can be reassured that there is no apparent increased risk of adverse fetal effects when using topical corticosteroids during pregnancy, although some data do suggest fetal growth restriction with more potent topical corticosteroids 2.
- A study published in JAMA dermatology found that the available evidence showed 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 maternal use of potent to very potent topical corticosteroids was associated with low birth weight 4.
- Another study published in The Cochrane database of systematic reviews found that 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 6.
- However, a study published in Prescrire international recommended avoiding the use of a cream containing 5% aciclovir and 1% hydrocortisone during pregnancy, given the mild nature of herpes labialis and concerns over the risks of corticosteroids for the unborn child 5.
Potential Risks and Considerations
- The use of potent to very potent topical corticosteroids, especially when the cumulative dosage of topical corticosteroids throughout the pregnancy is very large, may be associated with low birth weight 4, 6.
- Maternal use of mild to moderate potency topical steroids may be associated with a decreased risk of fetal death, but this effect was not observed with potent to very potent topical corticosteroids 6.
- The quality of the evidence was generally considered low due to imprecision and inconsistency in some of the studies 6.