Is hydrocortisone cream safe during pregnancy?

What does the evidence say about hydrocortisone cream during pregnancy?

1. Studies looking at topical corticosteroid exposure, the category hydrocortisone cream belongs to, haven't found an increased chance of birth defects. 1
2. Only a small amount of a topical corticosteroid is expected to be absorbed into the bloodstream with typical use, though absorption rises with stronger formulations, larger application areas, and broken skin. 1
3. A cohort study of more than 60,000 pregnancies found no increased risk of low birth weight or a baby being small for gestational age with topical corticosteroid use, even among women dispensed more than 300 grams of a potent or very potent product across the whole pregnancy. 2
4. Topical hydrocortisone hasn't been directly studied during breastfeeding, but short-term use on a small area isn't expected to pose a risk to a nursing baby through breast milk, and guidelines allow application to the nipples after a feeding if they're cleaned before the next one. 3
5. Mild-to-moderate potency topical corticosteroids are the standard first step for itchy pregnancy skin conditions like PUPPP, alongside emollients and antihistamines, with clinical guidance describing topical corticosteroids as safe in pregnancy and lactation when used at the smallest effective dose for the shortest period needed. 4

Is hydrocortisone cream safe in each trimester?

• First trimester. First-trimester use of low-potency hydrocortisone for occasional itching, like a bug bite or mild rash, hasn't been linked to a higher rate of birth defects in the studies MotherToBaby has reviewed.
• Second trimester. If itching is new and widespread rather than confined to a small patch, tell your provider before managing it yourself. Conditions like cholestasis of pregnancy cause itching that a steroid cream will not address and that needs its own workup.
• Third trimester. Itchy rashes like PUPPP are most common in the third trimester, and mild-to-moderate topical corticosteroids are the usual first step alongside emollients and antihistamines. Very potent formulations used over large areas for a long stretch are the pattern some earlier studies connected to lower birth weight, so stick to the smallest area and shortest course your provider recommends.

Hydrocortisone potency and the pregnancy evidence