Importance: Topical corticosteroids are indicated for pregnant women with skin conditions, but their safety in pregnancy is not fully understood.

Objective: To investigate whether maternal exposure to topical corticosteroids results in adverse pregnancy outcomes.

Design: Retrospective cohort study.

Setting: United Kingdom National Health Service.

Participants: A total of 2658 pregnant women exposed to topical corticosteroid and 7246 unexposed pregnant women.

Exposure: Topical corticosteroids dispensed during pregnancy.

Main outcomes and measures: Orofacial cleft, low birth weight, preterm delivery, fetal death, low Apgar score, and mode of delivery.

Results: No associations of maternal topical corticosteroid exposure with orofacial cleft, low birth weight, preterm delivery, fetal death, low Apgar score, and mode of delivery were found in the primary analysis (adjusted risk ratio [RR], 1.85 [95% CI, 0.22-15.20] [P = .57]; 0.97 [95% CI, 0.78-1.19] [P = .75]; 1.20 [95% CI, 0.73-1.96] [P = .48]; 1.07 [95% CI, 0.56-2.05] [P = .84]; 0.84 [95% CI, 0.54-1.31] [P = .45]; and P = .76, respectively). Stratified analyses based on potency did not reveal any significant associations in most of these categories either, but an exploratory analysis showed a significantly increased risk of low birth weight when the dispensed amount of potent or very potent topical corticosteroids exceeded 300 g during the entire pregnancy (adjusted RR, 7.74 [95% CI, 1.49-40.11]; P = .02).

Conclusions and relevance: This study reassuringly showed no associations of maternal topical corticosteroid exposure with orofacial cleft, preterm delivery, fetal death, low Apgar score, and mode of delivery. With this study and all available evidence taken together, the risk of low birth weight seems to correlate with the quantity of topical corticosteroid exposure.