From the Guidelines
Topical corticosteroids can be safely used during pregnancy to manage atopic dermatitis (eczema), as the risk of systemic absorption is minimal with appropriate use, making them safe for both mother and baby. When using topical steroids during pregnancy, it is essential to choose low to moderate potency options, such as hydrocortisone 1%, triamcinolone 0.1%, or mometasone, and apply them in a thin layer to affected areas once or twice daily for the shortest duration needed to control symptoms, typically 1-2 weeks for flares 1. For maintenance, these medications can be used intermittently as needed. It is crucial to avoid using very high potency steroids like clobetasol for extended periods or over large body areas during pregnancy, as this may increase the risk of systemic absorption and potential harm to the fetus.
Key Considerations
- Use the lowest effective dose of topical corticosteroids to minimize potential risks
- Choose low to moderate potency options, such as hydrocortisone 1%, triamcinolone 0.1%, or mometasone
- Apply topical corticosteroids in a thin layer to affected areas once or twice daily for the shortest duration needed to control symptoms
- Avoid using very high potency steroids like clobetasol for extended periods or over large body areas during pregnancy
- Complement steroid treatment with regular moisturizing using fragrance-free emollients and gentle skin care practices
Additional Guidance
According to the most recent evidence, glucocorticoids, such as prednisone, are considered compatible with pregnancy, although there may be a possible association with oral clefting 1. However, this evidence is related to oral glucocorticoids, and the risk of systemic absorption with topical corticosteroids is minimal when used appropriately. If eczema is severe or unresponsive to topical steroids, it is essential to consult a healthcare provider for additional treatment options that remain safe during pregnancy.
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 corticosteroids during pregnancy is not entirely safe and should be approached with caution. Topical corticosteroids should only be used if the potential benefit justifies the potential risk to the fetus. Key considerations include:
- Limited use: Drugs of this class should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time.
- Risk of teratogenic effects: Corticosteroids have been shown to be teratogenic in laboratory animals, and there are no adequate studies in pregnant women to fully understand the risks.
- Potential harm to the fetus: The potential risk to the fetus should be carefully weighed against the potential benefits of using topical corticosteroids during pregnancy 2.
From the Research
Safety of Topical Corticosteroids in Pregnancy
The use of topical corticosteroids during pregnancy has been studied in various research papers. According to 3, a guideline subcommittee of the European Dermatology Forum developed an evidence-based guideline on the use of topical corticosteroids in pregnancy, which suggested that mild/moderate topical corticosteroids are preferred to potent/very potent ones in pregnancy due to the associated risk of fetal growth restriction with the latter.
Key Findings
- A large population-based cohort study found a significant association of fetal growth restriction with maternal exposure to potent/very potent topical corticosteroids, but not with mild/moderate topical corticosteroids 3.
- No associations of maternal exposure to topical corticosteroids of any potency with orofacial cleft, preterm delivery, and fetal death were found 3, 4.
- A Cochrane Review suggested that the major possible adverse effects on the fetus of topical corticosteroids were orofacial clefts when used preconceptionally and in the first trimester of pregnancy, and fetal growth restriction when very potent topical corticosteroids were used during pregnancy 3.
- Stratified analyses based on steroid potency found no association between maternal use of topical corticosteroids of any potency and an increase in adverse pregnancy outcomes, including mode of delivery, congenital abnormality, preterm delivery, fetal death, and low Apgar score 4.
Recommendations
- 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 5.
- Women should be prescribed the lowest potency required whenever possible 5.
- The management of atopic dermatitis during pregnancy requires special precautions to avoid harming the fetus, and topical corticosteroids can be used with caution 6, 7.