Intranasal triamcinolone use during pregnancy and the risk of adverse pregnancy outcomes

• Published in: Journal of allergy and clinical immunology 2016-07, Vol.138 (1), p.97-104.e7
• Main Authors: Bérard, Anick, MSc, PhD, Sheehy, Odile, MSc, Kurzinger, Marie-Laure, MSc, Juhaeri, Juhaeri, PhD
• Format: Article
• Language: English
• Subjects: Abortion; Abortion, Spontaneous - epidemiology; Abortion, Spontaneous - etiology; Administration, Intranasal; Adult; Age; Allergies; Allergy and Immunology; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - adverse effects; Archives & records; Asthma; Birth weight; Canada - epidemiology; Comorbidity; Congenital Abnormalities - epidemiology; Congenital Abnormalities - etiology; Congenital diseases; FDA approval; Female; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Health risk assessment; Humans; Infant, Small for Gestational Age; Longitudinal Studies; major congenital malformations; Maternal Exposure - adverse effects; Musculoskeletal system; Odds Ratio; Pregnancy; Pregnancy Outcome; Prescription drugs; Public Health Surveillance; rhinitis; Risk Factors; small for gestational age; spontaneous abortions; Triamcinolone; Triamcinolone - administration & dosage; Triamcinolone - adverse effects; Womens health; Young Adult
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2016.01.021

Background Intranasal corticosteroid use during pregnancy has increased over the past decade. Objective We aim to estimate the safety of intranasal triamcinolone use during pregnancy, which was introduced for over-the-counter use in October 2013. Methods We designed a population-based prospective cohort study. From a cohort of 289,723 pregnancies in Montreal, Quebec, Canada, from 1998-2008, intranasal triamcinolone–exposed, other intranasal corticosteroid–exposed, and nonexposed women during the first trimester were studied for major congenital malformations (overall and organ specific) and spontaneous abortions and during the second/third trimesters for small-for-gestational age (SGA) newborns. The first trimester is the time window of interest for malformations and spontaneous abortion (organogenesis), and the second/third trimesters are the time windows of interest for SGA (fetal growth). Logistic regression model–based generalized estimating equations were used. Results Adjusting for potential confounders, use of intranasal triamcinolone during the first trimester of pregnancy was not significantly associated with the risk of overall congenital malformations (odds ratio [OR], 0.88; 95% CI, 0.60-1.28; 31 exposed cases) compared with nonexposure; however, it was associated with the risk of respiratory defects (OR, 2.71; 95% CI, 1.11-6.64; 5 exposed cases). Pregnancy exposure to intranasal triamcinolone was not significantly associated with the risk of spontaneous abortion (OR, 1.04; 95% CI, 0.76-1.43; 50 exposed cases). No association was found between second- or third-trimester exposure to intranasal triamcinolone and the risk of SGA (OR, 1.06; 95% CI, 0.79-1.43; 50 exposed cases). Conclusions Maternal exposure to intranasal triamcinolone during pregnancy was not associated with the risk of SGA/spontaneous abortions/overall malformations. However, it has been shown to increase the risk of respiratory system defects. Chance finding cannot be ruled out.