Topical corticosteroid use in pregnancy may not increase risk of SGA or low birth weight: JAMA

Primary outcomes were SGA and low birth weight. Association between outcomes and exposure was assessed by relative risk ratios (RRs) and absolute risk differences (ARDs).

• Among the 60,497 matched pregnancies exposed to topical corticosteroids, 5678 (9.4%) of the delivered infants were born SGA compared with 22,634 infants (9.4%) among the matched unexposed pregnancies (RR, 1.00; 95% CI, 0.98-1.03 and ARD, 0.3; 95% CI, −2.3 to 2.9 per 1000 pregnancies).

• Low birth weight occurred in 2006 (3.3%) of the exposed pregnancies compared with 8675 (3.6%) of the unexposed pregnancies (RR, 0.92; 95% CI, 0.88-0.97 and ARD, −2.7; 95% CI, −4.3 to −1.1 per 1000 pregnancies).

• Exposure to potent to very potent topical corticosteroids at any amount was not associated with an increased risk of SGA (RR, 1.03; 95% CI, 0.99-1.07) or low birth weight (RR, 0.94; 95% CI, 0.88-1.00).

• Post hoc analyses did not find a significant increased risk among those receiving large amounts of potent to very potent topical corticosteroids (ie, >200 g throughout pregnancy) compared with unexposed pregnancies (RR, 1.17; 95% CI, 0.95-1.46 for SGA and RR 1.14; 95% CI, 0.81-1.60 for low birth weight).

In this propensity score–matched cohort study that included 60 497 pregnancies exposed to topical corticosteroids derived from a nationwide cohort of 1.1 million live birth singleton pregnancies, no association was observed between topical corticosteroid exposure in pregnancy and increased risk of SGA or low birth weight. In addition, analyses in strata of the cumulative dosage did not find a significant increased risk of SGA or low birth weight associated with use of large amounts of potent to very potent topical corticosteroids, and the upper bounds of the 95% CIs exclude a moderate to large increase in the rates among exposed pregnancies.

The secondary analyses performed in the current study found a nonsignificant increase in the RR in pregnancies having received more than 200 g of potent to very potent agents. These results suggest that any potential attributable risk associated with topical corticosteroid exposure would likely be of limited clinical relevance.

The authors concluded, "This nationwide cohort study found no association between topical corticosteroid use in pregnancy and an increased risk of SGA or low birth weight. Although the findings cannot definitively rule out the possibility of an increased risk, a moderate to large increase in the rates is unlikely. Thus, these findings suggest that topical corticosteroids, including potent to very potent agents, in large amounts can be used in pregnancy without increased concerns of SGA and low birth weight."

Source: Niklas Worm Andersson; Lone Skov, Jon Trærup Andersen, JAMA Dermatol. 2021;157(7):788-795.

doi:10.1001/jamadermatol.2021.1090