Pregnancy outcomes following first-trimester exposure to topical retinoids: a systematic review and meta-analysis

• Published in: British journal of dermatology (1951) Vol. 173; no. 5; pp. 1132 - 1141
• Main Authors: Kaplan, Y.C., Ozsarfati, J., Etwel, F., Nickel, C., Nulman, I., Koren, G.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2015
• Subjects: Abnormalities, Drug-Induced - etiology; Abortion, Induced - statistics & numerical data; Abortion, Spontaneous - chemically induced; Acne Vulgaris - drug therapy; Administration, Cutaneous; Dermatologic Agents - administration & dosage; Dermatologic Agents - adverse effects; Epidemiologic Methods; Female; Humans; Infant, Low Birth Weight; Maternal Exposure - adverse effects; Pregnancy; Pregnancy Complications - chemically induced; Pregnancy Outcome; Pregnancy Trimester, First; Premature Birth - chemically induced; Retinoids - administration & dosage; Retinoids - adverse effects; Stillbirth
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.14053

Summary Evaluation of human data regarding the outcomes of topical‐retinoid‐exposed pregnancies is important in terms of counselling pregnant women with inadvertent exposure. The objective of this study was thus to determine whether exposure to topical retinoids leads to an increase in the risk of adverse pregnancy outcomes. We carried out a search using the Medline, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases from inception to 4 December 2014. The selection, review and quality assessment of the studies were carried out by two independent reviewers according to predetermined inclusion criteria. Odds ratios (ORs) were calculated by the random effects method. This meta‐analysis, including a total of 654 pregnant women who were exposed to topical retinoids, and 1375 unexposed control pregnant women, did not detect significant increases in rates of major congenital malformations [OR 1·22, 95% confidence interval (CI) 0·65–2·29], spontaneous abortions (OR 1·02, 95% CI 0·64–1·63), stillbirth (OR 2·06, 95% CI 0·43–9·86), elective termination of pregnancy (OR 1·89, 95% CI 0·52–6·80), low birthweight (OR 1·01, 95% CI, 0·31–3·27) or prematurity (OR 0·69, 95% CI 0·39–1·23). No significant heterogeneity was detected among the studies for the evaluated outcomes. The present meta‐analysis ruled out a major increase in the rates of major congenital malformations, spontaneous abortions, low birthweight and prematurity. This result may be used primarily in reassuring women who were inadvertently exposed to topical retinoids during their pregnancy. However, the statistical power is not adequate to justify the use of topical retinoids during pregnancy. What's already known about this topic? Although topical retinoids have been on the market for about half a century, data regarding their use and/or exposure in pregnancy are limited. Malformations in the infants of topical‐retinoid‐exposed pregnant women have been reported in individual case reports. This raises concerns regarding a possible association, which has not been confirmed in controlled epidemiological studies. What does this study add? Our systematic review and meta‐analysis does not suggest an association between exposure to topical retinoids in the first trimester and the risk of major congenital malformations and other adverse pregnancy outcomes. These results may offer reassurance for pregnant women with inadvertent exposure. The relatively small sample size does not allow justification for the use of topical retinoids during pregnancy. Linked Comment: Tada, Br J Dermatol 2015; 173: 1117–1118.