Corticosteroid creams and ointments

(Date: December 2016. Version: 1)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

What are they?

Corticosteroids are a group of medicines that reduce inflammation in the body and suppress the immune system. Corticosteroid creams, and ointments (hydrocortisone, alclometasone, beclometasone, betamethasone, clobetasol, clobetasone, diflucortolone, fludroxycortide, fluocinolone, fluocinonide, fluocortolone, fluticasone, mometasone, and triamcinolone) are used to treat skin conditions such as eczema, dermatitis, and psoriasis, and skin lesions associated with some auto-immune conditions such as lupus.

Corticosteroids differ in terms of the strength of their effects on the body. The medical term for this is steroid potency. A more potent steroid will have stronger effects than the same amount of a less potent steroid. For example, hydrocortisone is of mild potency, whereas beclometasone and betamethasone are moderately potent, and clobetasol is very potent. A corticosteroid cream or ointment prescribed by a doctor will have information about its potency in the printed leaflet that comes with the medicine, or on the label.

Is it safe to use corticosteroid creams or ointments in pregnancy?

There is currently no good evidence that corticosteroid creams or ointments, when used as prescribed, are harmful to a baby in the womb. However, because not all possible effects have been studied and a small number of studies have raised concerns, ongoing research is needed.

The requirement for a specific treatment varies from person to person and is dependent on factors such as the severity of the illness and the complications that could arise if treatment is altered or stopped. When deciding whether to use corticosteroid creams and ointments during pregnancy it is important to weigh up how necessary they are to your health against any possible risks to you or your baby, some of which might depend on how many weeks pregnant you are. Your doctor is the best person to help you decide what is right for you and your baby.

Women who use corticosteroid creams and ointments in pregnancy should closely follow their doctor’s instructions regarding how much of the product to use so that they are using no more than is needed. The amount of corticosteroid from a cream or ointment that enters a woman’s bloodstream may be increased if the skin to which it is applied is of a large area or broken, or if the skin is covered with a dressing after application of the cream or ointment. In cases where higher than usual blood levels of steroid are expected, it may be helpful to consider the information on the bumps leaflet on fetal effects of systemic corticosteroid use in pregnancy. 

What if I have already used corticosteroid creams or ointments during pregnancy?

If you are using any medicines in pregnancy, it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether you still need all the medicines that you are on, and to make sure that you are taking the lowest dose that works.

Can using corticosteroid creams or ointments in pregnancy cause my baby to be born with birth defects?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

In animal studies, corticosteroid tablets given by mouth increased the occurrence of cleft lip and palate in baby rats, mice, and rabbits. Although eight of the eleven studies of pregnant women using corticosteroid creams or ointments in pregnancy did not find a link with cleft lip and palate in babies, three studies (including one very large study) did. It is noteworthy that the majority of studies of pregnant women taking corticosteroid tablets (from which greater amounts of corticosteroid are likely to reach the baby in the womb) do not show a link to cleft lip and palate in babies. It is therefore possible that the link with cleft lip and palate identified in the three studies of corticosteroid creams and ointments may have been due to other factors, such as other medicine use, or illness in the mothers. It is however possible that specific types of steroid cream/ointment, or use of very high doses of steroid creams/ointments can affect a baby’s lip and palate development in the womb. Studies designed to examine these potential effects are therefore needed.

Neither of the two studies that investigated whether hypospadias (where the opening of the penis is on the underside rather than at the tip) is more common in male babies whose mothers used corticosteroid creams or ointments in pregnancy found a that this was the case. Further studies are required to confirm these findings.

Rates of other specific birth defects have not been studied in a large enough number of pregnant women who used corticosteroid creams or ointments to accurately assess the risk of these defects in the baby. Further research into the rates of other birth defects in babies whose mothers used corticosteroid creams or ointments in pregnancy is therefore required.

Can using corticosteroid creams or ointments in pregnancy cause miscarriage?

The only study carried out so far that has investigated miscarriage rates found no increased risk in around 1,100 pregnant women using corticosteroid creams or ointments. The study also found no increase in the occurrence of miscarriage amongst women using high potency corticosteroids. Further studies into this subject are required to confirm this finding.

Can using corticosteroid creams or ointments in pregnancy cause stillbirth?

Two studies which analysed the likelihood of stillbirth among a total of 18,500 pregnant women using corticosteroid creams/ointments both found no increased risk of stillbirth. One of these studies also showed that stillbirth was no more common in the women using high potency corticosteroids.

Can using corticosteroid creams or ointments in pregnancy cause preterm birth?

None of four studies of a total of over 14,000 babies born to women using corticosteroid creams or ointments in pregnancy found that such use increases the chance of preterm birth. Use of higher potency corticosteroids also did not increases the risk of preterm birth.

Can using corticosteroid creams or ointments in pregnancy cause low birth weight in the baby?

Four studies, which together include over 20,000 babies born to women using corticosteroid creams and ointments in pregnancy, found no link with the baby having a low birth weight. Three of these studies also investigated whether certain potencies or amounts of corticosteroid creams or ointments might affect the baby’s birth weight. In two of the studies, babies born to mothers who used higher potencies or amounts of corticosteroids, were more likely to have a low birth weight. In contrast, a third study did not show that use of high potency corticosteroid creams or ointments increased the chance of low birth weight in the baby. More research into the possible effects of exposure in the womb to high potency or large amounts of corticosteroid creams or ointments is therefore required.

Can using corticosteroid creams or ointments in pregnancy cause learning or behavioural problems in the child?

A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.

No studies have yet investigated the learning and behaviour of children whose mothers used corticosteroid creams or ointments during pregnancy.

Will my baby need extra monitoring during pregnancy?

As part of their routine antenatal care most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.

There is no evidence that using a corticosteroid cream or ointment during pregnancy causes problems that would require extra monitoring of your baby. However, pregnant women with some of the conditions that corticosteroid creams or ointments might be used to treat (such as skin lesions related to lupus or other auto-immune conditions) might receive extra monitoring during pregnancy to ensure that they remain healthy and that the baby is growing and moving as expected.

Are there any risks to my baby if the father has used topical corticosteroids?

We would not expect any increased risk to your baby if the father used a topical corticosteroid before or around the time you became pregnant.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.  

General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

   

www.medicinesinpregnancy.org

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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