Topical corticosteroid use in pregnancy may not increase risk of SGA or low birth weight: JAMA
The prevalence of topical corticosteroid use during pregnancy is reported to be as high as 7%. Data to help evaluate potential fetal harm from topical corticosteroid use in pregnancy are limited and conflicting. In particular, there are current concerns about a potential risk of low birth weight with use of potent to very potent topical corticosteroids in pregnancy, especially when the cumulative dosage throughout pregnancy is large. Thus, the most recent guideline recommends the use of topical corticosteroids with mild to moderate potency (eg,hydrocortisone and hydrocortisone butyrate) in pregnancy,whereas potent to very potent agents (eg, mometasone furoate, betamethasone, and clobetasol) should be used only as second-line therapy and for a short period.
Niklas Worm Andersson and team evaluated the association between topical corticosteroid use and SGA and low birthweight compared with no use in a propensity score–matched analysis on a pregnancy cohort derived from the entire Danish population during the study period 1997-2016.
From a source cohort of 1.1 million pregnancies with individual-level informed data from various registries, this nationwide cohort study identified topical corticosteroid–exposed pregnancies in Denmark from January 1, 1997, to December 31, 2016, for a total of 60 497, that were matched with 241 986 unexposed pregnancies on the basis of propensity scores, including a wide set of baseline characteristics. Data analysis was performed from September 8, 2020, to February 23, 2021. Exposure included filled prescriptions for topical corticosteroids during pregnancy.
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.