Topical Cream and Healthy Babies

No one wants to deal with itchy, dry, inflamed skin— especially not with a baby on the way. Worrying about the side effects of topical creams on pregnancy only makes the situation worse. But results from a new study may soothe that worry.

Animal studies have shown that certain types of topical creams cause negative effects on fetuses.However, a recent study that looked at actual women found that there was no significant risk to using prescribed topical (applied directly to the skin)medicine to treat skin conditions during pregnancy.

Researchers analyzed data from thousands of pregnant women to see if there was an association between topical treatment and their baby's health.These researchers concluded that normal amounts of topical anti-inflammatory cream appeared safe for pregnant women and their babies.

Ching-Chi Chi, MD, of the Department ofDermatology and Centre for Evidence-BasedMedicine of the Chang Gung University College ofMedicine, and colleagues conducted this study to find out if topical corticosteroids had any effect on pregnancy.

Topical corticosteroids are commonly used to reduce inflammation. They are frequently used for treating skin conditions like rashes, eczema, as well as allergic reactions that cause breakouts.

About 6 percent of pregnant women are prescribed topical corticosteroids. However, their safety for pregnant women is not fully known. In animal studies, topical corticosteroids have restricted fetal growth.

Previous clinical research on pregnant women, their babies and topical corticosteroids is limited. Small studies have suggested that these medications could be linked to low birth weight and cleft palates. The researchers used data from the Health Informatics Centre from 1989 to 2006 for this study. This database contains anonymous medical records of individuals in Scotland.

The researchers looked at women from 15 to 44years old who received prescriptions for topical corticosteroids during pregnancy. Women who received any other type of administration of the steroids were excluded. They also looked at a control (comparison) group of women, 15 to 44years old, who did not receive topical corticosteroids during their pregnancy.

In total, the researchers examined the medical data of 2,658 women who used topical corticosteroids, including 757 who used the medicine during the first12 weeks of pregnancy, when cleft palates tend to form. They compared them to a control group of7,246 women who had not been exposed to the steroids.

The researchers analyzed occurrences of cleft lips or palates, low birth weight, pre-term delivery, fetal death, mode of delivery and low Apgar score, a measure for evaluating the health of a newborn.They found that there was no significant association between topical corticosteroids and cleft lips or palates, preterm delivery, fetal death, mode of delivery or low Apgar score.

This study also showed no association with lower birth weights, although there was some evidence of lower birth weights among women prescribed large amounts of very strong steroids. Those women were prescribed about 300 grams over the course of pregnancy, and the average study participant was prescribed about 64 grams.

“This is a good study. The study was based on a review of topical steroids prescribed to pregnant patients and a comparison to a matched group of non-pregnant patients. Records were tracked from the pharmacy and used to identify the study patient.It states that the use of most topical steroids are safe in pregnancy. Only potent and very potent topical steroids pose the small possibility of pregnancy complications such as a low birth weight baby," Ronald E. de la Pena, MD, a gynecologist atLos Robles Hospital in Thousand Oaks, CA, told dailyRx News.

"However, the study was limited in that actual use of the prescribed topical corticosteroid was unknown. So if the topical steroid use was less than estimated, the risk of adverse pregnancy outcomes might have been underestimated. It would be helpful to have a study that tracked the actual use of topical steroids and the out comes in pregnancy," said Dr. de le Pena.

The study authors concluded that pregnant women do not have to worry about normal exposure to topical corticosteroids. However, if women are exposed to strong corticosteroids, the exposure should be limited and special attention should be paid to fetal growth.

This research was published online on September 4in JAMA Dermatology. The study was funded by theWellbeing of Women and Chang Gung MemorialHospital. The authors disclosed no conflicts of interest.

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