Corticosteroids Safely Treat Allergic Conjunctivitis in Pregnant Patients

Doctor wearing protective mask when writing prescription for her
A study reviews the neonatal outcomes of exposure to ophthalmic corticosteroids.

It is safe for pregnant patients to use topical ophthalmic corticosteroids to treat allergic conjunctivitis, according to findings published in the American Journal of Ophthalmology. 

Managing allergic conjunctivitis in patients who are pregnant can present clinical challenges, as corticosteroids have been linked to adverse effects on the fetus in animal studies, according to the US Food and Drug Administration. However, researchers say no adequate human studies have specifically looked at the association between ophthalmic corticosteroids and adverse neonatal outcomes. 

To address this, investigators conducted a retrospective review to analyze any association. The study included records from pregnant patients who were diagnosed with allergic conjunctivitis between 2005 and 2018. Congenital anomalies, preterm birth, low birth weight, and the composite of these 3 outcomes were compared between participants who did and did not receive topical ophthalmic corticosteroids during their first trimester of pregnancy. Propensity scores were calculated with known confounders, and then logistic regression was conducted with propensity score adjustment.

A total of 6847 eligible participants were identified, of whom 898 (13%) had received topical ophthalmic corticosteroids. Congenital abnormalities occurred in 5.5% of those who were not exposed to ophthalmic corticosteroids and 4.9% of those who were. Preterm birth occurred in 3.4% of controls and 3.9% of study patients. Low birth weight occurred in 5.9% of controls and 7.0% of study participants, respectively. The researchers ranked the composite outcome for the unexposed and exposed groups as  11.7%. Corticosteroid eye drops were not significantly associated with an increase in congenital abnormalities (P =.20); preterm birth (P =.35); low birth weight (P =.35), or composite outcome (P =.68).

This study had several limitations. First, it could not be determined if the patients used the ophthalmic corticosteroids prescribed, leading to a potential underestimation of the risks. Second, researchers couldn’t obtain information about the daily frequency and duration of treatment and couldn’t analyze dose-dependent effects. Third, the sample size might not have been large enough to draw firm conclusions. Fourth, it is possible that some adverse neonatal outcomes were not detected. Lastly, perinatal care practices in Japan, where the research was conducted, may limit the generalizability of the findings. 

“The use of ophthalmic corticosteroids during the first trimester was not associated with adverse neonatal outcomes,” the study concludes.


Hashimoto Y, Michihata N, Yamana H, et al. Ophthalmic corticosteroids in pregnant women with allergic conjunctivitis and adverse neonatal outcomes: propensity score analyses. Am J Ophthalmol. 2020;220:91-101. doi:10.1016/j.ajo.2020.07.011.