This sheet is about exposure to topical corticosteroids during pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.
What are topical corticosteroids?
Topical corticosteroids are medications that are put directly on the skin and have been used to treat skin conditions like eczema, psoriasis, and other rashes. They may be in the form of a lotion, cream, ointment, or gel. There are many different corticosteroids with different names. Topical corticosteroids include over the counter products such as hydrocortisone and stronger prescription medications such as clobetasol, betamethasone, or triamcinolone.
Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.
Topical corticosteroids are often a first line treatment during pregnancy for different skin conditions. This is because the amount of medication that can reach the developing pregnancy by absorption through the skin is much lower than with medications taken by mouth. For questions about a specific topical corticosteroid, talk with your healthcare provider or a MotherToBaby specialist
Does the amount that you put on your skin matter?
When used over large areas of skin, more medication can be absorbed into a person’s blood stream than when used on smaller areas of skin. Also, skin on certain parts of the body can absorb medication more easily than other areas. For example, more medication is absorbed through the face than from the soles of the hands and feet.
Does the strength of the topical medication matter?
Medication can vary in how strong the active ingredient is and in how much of the medication is in the product. The stronger the topical corticosteroid, the more likely a higher amount will be absorbed into the blood stream. Usually, it is suggested to use the lowest effective strength needed to treat your condition.
Are there other factors that affect how much medication is absorbed?
Less medication is likely to be absorbed through healthy, unbroken skin. More medication is thought to be absorbed through broken skin or if applied under a bandage or dressing. The more times the medication is applied on the skin, the more it can be absorbed.
I use topical corticosteroids. Can it make it harder for me to get pregnant?
It is not known if using topical corticosteroids can make it harder to get pregnant. Contact a MotherToBaby specialist to get the most current information available for the specific topical corticosteroid you are using.
Does using topical corticosteroids increase the chance for miscarriage?
Miscarriage is common and can occur in any pregnancy for many different reasons. Based on the studies reviewed, the use of topical corticosteroids is not expected to increase the chance for miscarriage.
Does using topical corticosteroids increase the chance of birth defects?
Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Studies looking at topical corticosteroid exposure have not found an increased chance for birth defects. In many cases, only a small amount of the corticosteroid is expected to be absorbed with topical exposure, with little medication getting into the blood stream.
There has been some conflicting information about the use of oral corticosteroids (taken as pills) during the first trimester. Older studies suggested a possible increased chance for having a baby with a cleft lip (an opening in the upper lip) with or without a cleft palate (opening in the roof of the mouth). Newer studies and further review of the older studies do not support this. Also, taking a corticosteroid by mouth would result in a much greater amount of the medication in your blood stream, compared to topical use.
Does using topical corticosteroids in pregnancy increase the chance of other pregnancy-related problems?
Not all topical corticosteroids have been well studied in pregnancy. When used as directed, topical corticosteroids would be unlikely to greatly increase the chance for pregnancy complications. The use of very strong corticosteroids over large areas of the body for a long time might be associated with lower birth weight.
Does using topical corticosteroids in pregnancy affect future behavior or learning for the child?
Based on the studies reviewed, it is not known if using topical corticosteroids increases the chance for behavior or learning issues.
Breastfeeding while using topical corticosteroids:
Not all topical corticosteroids have been well studied for use in breastfeeding. In most cases, high absorption into the blood stream and passing into milk in large amounts would only be expected with very strong corticosteroids used on large areas of the body. Medications placed on the breast or nipple area should be wiped off before breastfeeding or coming into contact with your baby’s skin and mouth. Wash your hands well after applying the medication. Be sure to talk to your healthcare provider about all of your breastfeeding questions.
If a male uses topical corticosteroids, could it affect fertility (ability to get partner pregnant) or increase the chance of birth defects?
Based on the studies reviewed, it is not known if topical corticosteroids could affect male fertility or increase the chance of birth defects above the background risk. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.
There is a registry for betamethasone in the treatment of autoimmune diseases. You can call 877-311-8972. For information online: https://mothertobaby.org/pregnancy-studies/.
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OTIS/MotherToBaby encourages inclusive and person-centered language. While our name still contains a reference to mothers, we are updating our resources with more inclusive terms. Use of the term mother or maternal refers to a person who is pregnant. Use of the term father or paternal refers to a person who contributes sperm.