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Systematic review of the safety of topical corticosteroids in pregnancy
Chi CC, Wang SH, Kirtschig G, Wojnarowska F
J Am Acad Dermatol. 2010;62(4):694-705.

Les conclusions de cette étude sont qu'il n'y a probablement pas de risque fœtal significatif en cas d'utilisation des dermocorticoïdes chez les femmes enceintes. Les 2 restrictions proposées par les auteurs sont d'éviter, autant que faire ce peut, les dermocorticoïdes de classe I pendant la grossesse et deuxièmement d'éviter l'application des dermocorticoïdes entre les semaines 5 et 12 où le risque de malformations oro-faciales est théoriquement le plus important

Question: Pregnant women may have skin conditions that require topical corticosteroid use. Is topical corticosteroid use safe during pregnancy?

Data Sources: A systematic review was performed of studies on the safety of topical corticosteroid use during pregnancy. Seventeen databases and trial registers were searched, and pharmaceutical companies were contacted. Randomized controlled cohort studies and case-control studies of pregnant women with topical corticosteroid use were included.

Study Selection: Seven studies, including 2 cohort studies and 5 case-control studies, were included in the analysis. The Newcastle-Ottawa Scale was used for quality assessment of included studies.

Data Extraction: Data were extracted on congenital abnormality, orofacial cleft, fetal growth, preterm delivery, fetal death (miscarriage and stillbirth), low Apgar score, and mode of delivery.

Data Synthesis: Most studies found no significant association of topical corticosteroid use with congenital abnormality, preterm delivery, stillbirth, or mode of delivery. One study found a significant association of first-trimester topical corticosteroid use with orofacial cleft, and another study found a significant association of very potent topical corticosteroid use with low birth weight. The available data were limited and mainly concerned orofacial cleft. The quality of evidence was generally low.

Conclusions: Limited and inconclusive data demonstrate no association of topical corticosteroid use with congenital abnormality, preterm delivery, or stillbirth. The current evidence shows no statistically significant difference in outcomes between pregnant women who use vs those who do not use topical corticosteroids. However, there seems to be an association of very potent topical corticosteroid use with low birth weight. Further cohort studies are needed with a large sample size, comprehensive outcome measures, and consideration of corticosteroid potency, dosage, and indications.

J Am Acad Dermatol. 2010;62(4):694-705.
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