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14-04-2011 | General practice | Article

First trimester corticosteroid use ok


Free abstract

The use of corticosteroids during the first trimester of pregnancy does not significantly increase the risk of orofacial defects, show the results of a Danish study.

The study involved data for 832,636 live births in Denmark during 1996-2008, including 1232 infants with orofacial clefts diagnosed during the first year of life. Information on all corticosteroid prescriptions filled by mothers from 4 weeks before pregnancy until birth was obtained from the Danish Prescription Drug Register.

Anders Hviid and Ditte Mølgaard-Nielsen from Statens Serum Institute in Copenhagen report that women who used any corticosteroid during the first trimester of pregnancy were not significantly more likely to have an infant with a cleft lip with, or without a cleft palate (odds ratio [OR]=1.05), or a cleft palate alone (OR=1.23) than women who did not use corticosteroids during the first trimester.

Interestingly, while inhalant, nasal spray and other topical corticosteroids showed no association with orofacial risk, the use of dermatologic corticosteroids in particular was associated with a 45% increased risk of cleft lip with or without cleft palate.

However, this may be a result of multiple statistical comparisons as opposed to causality, note the researchers in the Canadian Medical Association Journal.

Commenting on the findings to GP News, Jane Bass, a senior pharmacist and member of the UK Royal Pharmaceutical Society, said that despite previous animal and human studies indicating potential risks associated with steroids in pregnancy, it is important that women who need treatment get it.

Such patients include "asthmatics needing inhalers to prevent a severe asthma attack which may cause oxygen deprivation, patients with inflammatory bowel disease who need treatment for a flare, or treatment for eczema or arthritis," she said.

Bass explained: "Current practice is to use the lowest dose of steroid that will maintain maternal health while minimising risk to the foetus."

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Sarah Guy