Skip to main content
NCBI home page
Canadian Family Physician logoLink to Canadian Family Physician
. 2004 Aug;50:1083–1085.

Using corticosteroids during pregnancy. Are topical, inhaled, or systemic agents associated with risk?

D Oren 1, I Nulman 1, M Makhija 1, S Ito 1, Gideon Koren 1
PMCID: PMC2214644  PMID: 15455804

Abstract

QUESTION: I am concerned about use of corticosteroids during pregnancy. Some of my women patients of reproductive age are using topical, inhaled, or oral preparations, and I am not sure what to advise. ANSWER: Both topical and systemic corticosteroids are used for a variety of autoimmune and inflammatory conditions. Results of first-trimester studies were inconclusive and underpowered. Recent meta-analyses suggest a small but significant association between use of systemic corticosteroids during the first trimester and oral clefts. This is consistent with results of animal studies. No similar evidence exists for topical or inhaled corticosteroids, probably because of much lower systemic exposure.

Full Text

The Full Text of this article is available as a PDF (150.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnetson R. S., White A. D. The use of corticosteroids in dermatological practice. Med J Aust. 1992 Mar 16;156(6):428–431. doi: 10.5694/j.1326-5377.1992.tb139850.x. [DOI] [PubMed] [Google Scholar]
  2. Blais L., Suissa S., Boivin J. F., Ernst P. First treatment with inhaled corticosteroids and the prevention of admissions to hospital for asthma. Thorax. 1998 Dec;53(12):1025–1029. doi: 10.1136/thx.53.12.1025. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Carmichael S. L., Shaw G. M. Maternal corticosteroid use and risk of selected congenital anomalies. Am J Med Genet. 1999 Sep 17;86(3):242–244. doi: 10.1002/(sici)1096-8628(19990917)86:3<242::aid-ajmg9>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  4. Czeizel A. E., Rockenbauer M. Population-based case-control study of teratogenic potential of corticosteroids. Teratology. 1997 Nov;56(5):335–340. doi: 10.1002/(SICI)1096-9926(199711)56:5<335::AID-TERA7>3.0.CO;2-W. [DOI] [PubMed] [Google Scholar]
  5. Dombrowski M. P. Pharmacologic therapy of asthma during pregnancy. Obstet Gynecol Clin North Am. 1997 Sep;24(3):559–574. doi: 10.1016/s0889-8545(05)70322-3. [DOI] [PubMed] [Google Scholar]
  6. Donahue J. G., Weiss S. T., Livingston J. M., Goetsch M. A., Greineder D. K., Platt R. Inhaled steroids and the risk of hospitalization for asthma. JAMA. 1997 Mar 19;277(11):887–891. [PubMed] [Google Scholar]
  7. Gur Chamutal, Diav-Citrin Orna, Shechtman Svetlana, Arnon Judy, Ornoy Asher. Pregnancy outcome after first trimester exposure to corticosteroids: a prospective controlled study. Reprod Toxicol. 2004 Jan-Feb;18(1):93–101. doi: 10.1016/j.reprotox.2003.10.007. [DOI] [PubMed] [Google Scholar]
  8. Jana N., Vasishta K., Saha S. C., Khunnu B. Effect of bronchial asthma on the course of pregnancy, labour and perinatal outcome. J Obstet Gynaecol (Tokyo 1995) 1995 Jun;21(3):227–232. doi: 10.1111/j.1447-0756.1995.tb01002.x. [DOI] [PubMed] [Google Scholar]
  9. Melendres J. L., Bucks D. A., Camel E., Wester R. C., Maibach H. I. In vivo percutaneous absorption of hydrocortisone: multiple-application dosing in man. Pharm Res. 1992 Sep;9(9):1164–1167. doi: 10.1023/a:1015899721493. [DOI] [PubMed] [Google Scholar]
  10. Mintz G., Niz J., Gutierrez G., Garcia-Alonso A., Karchmer S. Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach. J Rheumatol. 1986 Aug;13(4):732–739. [PubMed] [Google Scholar]
  11. Mizuchi A., Miyachi Y., Tamaki K., Kukita A. Percutaneous absorption of betamethasone 17-benzoate measured by radioimmunoassay. J Invest Dermatol. 1976 Aug;67(2):279–282. doi: 10.1111/1523-1747.ep12514266. [DOI] [PubMed] [Google Scholar]
  12. Mogadam M., Dobbins W. O., 3rd, Korelitz B. I., Ahmed S. W. Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcome. Gastroenterology. 1981 Jan;80(1):72–76. [PubMed] [Google Scholar]
  13. Mok C. C., Wong R. W. Pregnancy in systemic lupus erythematosus. Postgrad Med J. 2001 Mar;77(905):157–165. doi: 10.1136/pmj.77.905.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mygind Helle, Thulstrup Ane Marie, Pedersen Lars, Larsen Helle. Risk of intrauterine growth retardation, malformations and other birth outcomes in children after topical use of corticosteroid in pregnancy. Acta Obstet Gynecol Scand. 2002 Mar;81(3):234–239. doi: 10.1034/j.1600-0412.2002.810308.x. [DOI] [PubMed] [Google Scholar]
  15. Norjavaara Ensio, de Verdier Maria Gerhardsson. Normal pregnancy outcomes in a population-based study including 2,968 pregnant women exposed to budesonide. J Allergy Clin Immunol. 2003 Apr;111(4):736–742. doi: 10.1067/mai.2003.1340. [DOI] [PubMed] [Google Scholar]
  16. PINSKY L., DIGEORGE A. M. CLEFT PALATE IN THE MOUSE: A TERATOGENIC INDEX OF GLUCOCORTICOID POTENCY. Science. 1965 Jan 22;147(3656):402–403. doi: 10.1126/science.147.3656.402. [DOI] [PubMed] [Google Scholar]
  17. Park-Wyllie L., Mazzotta P., Pastuszak A., Moretti M. E., Beique L., Hunnisett L., Friesen M. H., Jacobson S., Kasapinovic S., Chang D. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology. 2000 Dec;62(6):385–392. doi: 10.1002/1096-9926(200012)62:6<385::AID-TERA5>3.0.CO;2-Z. [DOI] [PubMed] [Google Scholar]
  18. Passalacqua G., Albano M., Canonica G. W., Bachert C., Van Cauwenberge P., Davies R. J., Durham S. R., Kontou-Fili K., Horak F., Malling H. J. Inhaled and nasal corticosteroids: safety aspects. Allergy. 2000 Jan;55(1):16–33. doi: 10.1034/j.1398-9995.2000.00370.x. [DOI] [PubMed] [Google Scholar]
  19. Pauwels Romain A., Pedersen Søren, Busse William W., Tan Wan C., Chen Yu-Zhi, Ohlsson Stefan V., Ullman Anders, Lamm Carl Johan, O'Byrne Paul M., START Investigators Group Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial. Lancet. 2003 Mar 29;361(9363):1071–1076. doi: 10.1016/S0140-6736(03)12891-7. [DOI] [PubMed] [Google Scholar]
  20. Rodríguez-Pinilla E., Martínez-Frías M. L. Corticosteroids during pregnancy and oral clefts: a case-control study. Teratology. 1998 Jul;58(1):2–5. doi: 10.1002/(SICI)1096-9926(199807)58:1<2::AID-TERA2>3.0.CO;2-4. [DOI] [PubMed] [Google Scholar]
  21. Schaefer H., Zesch A., Stüttgen G. Penetration, permeation, and absorption of triamcinolone acetonide in normal and psoriatic skin. Arch Dermatol Res. 1977 May 27;258(3):241–249. doi: 10.1007/BF00561126. [DOI] [PubMed] [Google Scholar]
  22. Tauscher Amanda E., Fleischer Alan B., Jr, Phelps Kathy C., Feldman Steven R. Psoriasis and pregnancy. J Cutan Med Surg. 2002 Oct 9;6(6):561–570. doi: 10.1007/s10227-001-0147-1. [DOI] [PubMed] [Google Scholar]
  23. Turpeinen M. Absorption of hydrocortisone from the skin reservoir in atopic dermatitis. Br J Dermatol. 1991 Apr;124(4):358–360. doi: 10.1111/j.1365-2133.1991.tb00597.x. [DOI] [PubMed] [Google Scholar]
  24. VICKERS C. F. Double-blind trial of betamethasone. Br Med J. 1962 Jan 20;1(5272):156–157. doi: 10.1136/bmj.1.5272.156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Venkataraman M. T., Shanies H. M. Pregnancy and asthma. J Asthma. 1997;34(4):265–271. doi: 10.3109/02770909709067216. [DOI] [PubMed] [Google Scholar]
  26. Walker B. E. Induction of cleft palate in rats with antiinflammatory drugs. Teratology. 1971 Feb;4(1):39–42. doi: 10.1002/tera.1420040107. [DOI] [PubMed] [Google Scholar]
  27. Warrell D. W., Taylor R. Outcome for the foetus of mothers receiving prednisolone during pregnancy. Lancet. 1968 Jan 20;1(7534):117–118. doi: 10.1016/s0140-6736(68)92723-2. [DOI] [PubMed] [Google Scholar]
  28. Wester R. C., Noonan P. K., Maibach H. I. Percutaneous absorption of hydrocortisone increases with long-term administration. In vivo studies in the rhesus monkey. Arch Dermatol. 1980 Feb;116(2):186–188. [PubMed] [Google Scholar]
  29. Witlin A. G. Asthma in pregnancy. Semin Perinatol. 1997 Aug;21(4):284–297. doi: 10.1016/s0146-0005(97)80071-7. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES