Advertisement

Maternal Use of Dermatologic Drugs and Infant Congenital Malformations

  • Bengt Källén
Chapter

Abstract

Most dermatologic drugs are used topically. Some of these have been linked to a teratogenic risk but according to modern literature this seems to be unlikely which is supported by new data for some of the most commonly used such drugs, e.g., topical corticosteroids. Topically used retinoids (e.g., tretinoin) should be avoided during pregnancy but presently available data do not suggest a marked teratogenic risk. Systemic use of retinoids (notably isotretinoin) should be avoided during pregnancy. If such exposure has occurred, interruption of pregnancy should be considered.

References

  1. Barbero P, Lotersztein V, Bronberg R, Perez M, Alba L. Acitretin embryopathy: a case report. Birth Defects Res A Clin Mol Teratol. 2004;70:831–3.CrossRefGoogle Scholar
  2. Benke PJ. The isotretinoin teratogen syndrome. JAMA. 1984;251:3267–9.CrossRefGoogle Scholar
  3. Bérard A, Azoulay L, Koren G, Blais L, Perreault S, Oraichi D. Isotretinoin, pregnancies, abortions and birth defects, Canada. Br J Clin Pharmacol. 2007;63:196–205.CrossRefGoogle Scholar
  4. Braun JT, Franciosi RA, Mastri AR, Drake RN, O’Neil BL. Isotretinoin dysmorphic syndrome. Lancet. 1984;1:506–7.CrossRefGoogle Scholar
  5. Camera G, Pregliasco P. Ear malformation in baby born to mother using tretinoin cream. Lancet. 1992;339:687.CrossRefGoogle Scholar
  6. Carmichael SL, Shaw GM, Ma C, Werler MM, Rasmussen SA, Lammer EJ, for the National Birth Defects Prevention Study. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol. 2007;197:585.e1–7.CrossRefGoogle Scholar
  7. Chi CC, Wang SH, Mayon-White R, Woynarowska F. Pregnancy outcomes after maternal exposure to topical corticosteroids: a UK population-based cohort study. JAMA Dermatol. 2013;149:1274–80.CrossRefGoogle Scholar
  8. Chi CC, Wang SH, Wojnarowska F, Kirtshig G, Davies E, Bennet C. Safety of topical steroids in pregnancy. Cochrane Database Syst Rev. 2015;(10):CD007346.  https://doi.org/10.1002/14651858.CD007346.pub3.
  9. Czeizel AE, Rockenbauer M. Population-based case-control study of teratogenic potential of corticosteroids. Teratology. 1997;56:335–40.CrossRefGoogle Scholar
  10. Edwards MJ, Agho K, Attia J, Diaz P, Hayes T, Illingworth A, Roddick G. Case-control study of cleft lip or palate after maternal use of topical corticosteroids during pregnancy. Am J Med Genet. 2003;120A:459–63.CrossRefGoogle Scholar
  11. Garcia-Bournissen F, Tsur L, Goldstein H, Staroselsky A, Avner M, Asrar F, Berkovitch M, Straface G, Koreon G, De Santis M. Fetal exposure to isotretinoin—an international problem. Reprod Toxicol. 2008;25:124–8.CrossRefGoogle Scholar
  12. Gunnarskog JG, Källén AJB, Lindelöf BG, Sigurdiersson B. Psoralen photochemotherapy (PUVA) and pregnancy. Arch Dermatol. 1999;129:320–3.CrossRefGoogle Scholar
  13. Happle R, Traupe H, Bonameaux Y, Fisch T. Teratogene Wirkung von Etretinat beim Menschen. Dtsch Med Wochenschr. 1984;109:1476–7.CrossRefGoogle Scholar
  14. Hviid A, Molgaard-Nielsen D. Corticosteroid use during pregnancy and risk of orofacial cleft. CMAJ. 2011;183:796–804.CrossRefGoogle Scholar
  15. Jick SS, Terris BZ, Jick H. First trimester topical tretinoin and congenital disorders. Lancet. 1993;341:1181–2.CrossRefGoogle Scholar
  16. Kaler SG, Patrinos ME, Lampert GH, Myers TF, Karlman R, Anderson CL. Hypertrichosis and congenital malformations associated with maternal use of mixodil. Pediatrics. 1987;79:434–6.PubMedGoogle Scholar
  17. Källén B. Drugs during pregnancy. New York: Nova Biomedical Books; 2009. p. 172.Google Scholar
  18. Lammer EJ, Chen DT, Hoar RM, Agnish ND, Benke PJ, Braun JT, Curry CJ, Fernhoff PM, Grix AW, Lott IT, Richard JM, Sun SC. Retinoic acid embryopathy. N Engl J Med. 1985;313:837–41.CrossRefGoogle Scholar
  19. Lipson AH, Collins F, Webster WS. Multiple congenital defects associated with maternal use of topical tretinoin. Lancet. 1993;341:1352–3.CrossRefGoogle Scholar
  20. Loureiro KD, Kao KK, Jones KL, Alvarado S, Chavez C, Dick L, Felix R, Johnson D, Chambers CD. Minor malformations characteristic of the retinoic acid embryopathy and other birth outcomes in children of women exposed to topical tretinoin during early pregnancy. Am J Med Genet. 2005;136A:117–21.CrossRefGoogle Scholar
  21. Mygind H, Thulstrup AM, Pedersen L, Larsen H. Risk of intrauterine growth retardation, malformations and other birth outcomes in children after topical use of corticosteroid in pregnancy. Acta Obstet Gynecol Scand. 2002;81:234–9.CrossRefGoogle Scholar
  22. Panchaud A, Csajka C, Merlob P, Schaefer C, Berlin M, De Santis M, Vial T, Ieri A, Malm H, Eleftheriou G, Stahl B, Rousso P, Winterfeld U, Rothuizen LE, Buclin T. Pregnancy outcome following exposure to topical retinoids: a multicenter prospective study. J Clin Pharmacol. 2012;52:1844–51.CrossRefGoogle Scholar
  23. Rojansky N, Fasouliotis SJ, Ariel I, Nadjari M. Extreme caudal agenesis. Possible drug-related etiology? J Reprod Med. 2002;47:241–5.PubMedGoogle Scholar
  24. Rosa FW. Teratogenicity of isotretinoin. Lancet. 1983;2:513.CrossRefGoogle Scholar
  25. Rosa FW, Idanpaan-Heikkila J, Asanti R. Fetal mixodil exposure. Pediatrics. 1987;80:120.PubMedGoogle Scholar
  26. Schaefer C, Meister R, Weber-Schoendorfer C. Isotretinoin exposure and pregnancy outcome: an observational study of the Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy. Arch Gynecol Obstet. 2010;281:221–7.CrossRefGoogle Scholar
  27. Shapiro L, Pastuszak A, Curto G, Koren G. Safety of first-trimester exposure to topical tretinoin: prospective cohort study. Lancet. 1997;350:1143.CrossRefGoogle Scholar
  28. Skuladottir H, Wilcox A, McConnaughey R, Vindenes H, Lie RT. First-trimester non-systemic corticosteroid use and the risk of oral clefts in Norway. Ann Epidemiol. 2014;24:635–40.CrossRefGoogle Scholar
  29. Smorlesi C, Caldarella A, Caramelli L, Di Lotto S, Moroni F. Topically applied minoxidil may cause fetal malformation. A case report. Birth Defects Res A Clin Mol Teratol. 2003;67:997–1001.CrossRefGoogle Scholar
  30. Stern RS, Lange R. Outcomes of pregnancies among women and partners of men with a history of exposure to methoxsalen photochemotherapy (PUVA) for the treatment of psoriasis. Arch Dermatol. 1991;127:347–50.CrossRefGoogle Scholar
  31. Zarowny FW. Accutane Roche risk of teratogenic effects. Can Med Assoc J. 1984;131:273.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Bengt Källén
    • 1
  1. 1.Tornblad Institute for Comparative EmbryologyLund UniversityLundSweden

Personalised recommendations