Most steroid skin creams likely safe during pregnancy

By Kathryn Doyle

Pregnant women can use corticosteroid creams without putting their fetus at risk, except for large amounts of very strong creams, a new study suggests.

In general, use of those ointments during pregnancy was not linked to cleft palate, preterm birth, low birth weight, or any other measured negative outcome, researchers found.

That's not surprising and is in line with previous research, said lead author Dr. Ching-Chi Chi of Chang Gung Memorial Hospital in Chiayi, Taiwan.

"This is not new information, however this article is reassuring to women who are using some topical corticosteroids," Dr. Heather Lipkind, an obstetrics researcher at Yale School of Medicine in New Haven who was not involved in the new study, told Reuters Health.

The researchers did find that when women used more than 300 g - the amount in six standard-size tubes - of very potent corticosteroids during pregnancy, babies were at increased risk of low birth weight, which is new, Dr. Chi said.

Using UK data from 1989 to 2006, the researchers compared rates of birth defects and delivery complications among babies born to about 2,700 women who were prescribed a corticosteroid cream during pregnancy and those born to 7,200 women who didn't use the drugs.

Overall, 4.7% of babies whose mothers had used corticosteroids were low birth weight, compared to 4.8% of babies born to controls. Just under 1% of both groups of babies were born before 37 weeks.

With potent creams, babies' risks also did not change when women used a total of 100 to 200 g of the drugs during their entire pregnancy. But when they used 300 g or more, the risk of low birth weight went up sevenfold.

The most potent topical creams include clobetasol propionate, betamethasone dipropionate and fluocinonide.

Steroids dysregulate placental hormones and probably prevent important proteins from getting to the baby, Dr. Chi told Reuters Health.

In his team's study, women who used the ointments were also more likely to have asthma and to take other high-risk medications during pregnancy than those who did not.

Skin irritation, discoloration and thickening are common during pregnancy, and corticosteroid creams are prescribed to about 6% of pregnant women, the researchers wrote September 4th in JAMA Dermatology.

Current guidelines recommend mild- or moderate-strength creams for pregnant women unless potent creams are absolutely necessary, which this study supports, Dr. Chi said.

If potent drugs are needed, doctors should monitor the growth of the fetus, he added.

"We would not recommend pregnant women stop using topical steroids just because of exaggerated fear of the potential side effects," Dr. Chi said. "We encourage women to apply topical steroids appropriately under physicians' guidance, which would treat skin conditions effectively and improve pregnant women's life quality."

SOURCE: http://bit.ly/1g0WJps

JAMA Dermatology 2013.