The etiology of intrahepatic cholestasis of pregnancy remains controversial. A family history of the condition is common, and there is an association with the presence of human leukocyte antigen-A31 (HLA-A31) and HLA-B8. 1 , 18 The condition tends to recur in subsequent pregnancies. 1 Patients may have a family history of cholelithiasis and a higher risk of gallstones. 25 , 26 The condition is associated with a higher risk of premature delivery, meconium-stained amniotic fluid, and intrauterine demise. A prospective cohort study demonstrated a correlation between bile acid levels and fetal complications, with a statistically significant increase in adverse fetal outcomes reported in patients with bile acid levels of mcg per mL (40 μmol per L) or more. 25
There is no evidence of safe and effective use of topical corticosteroids in pregnant mothers. Therefore, they should be used only if clearly needed. Long term use and large applications of topical corticosteroids may cause birth defects in the unborn. It is not known whether topical corticosteroids enter breast milk. Therefore, caution must be exercised before using it in nursing mothers. Topical corticosteroids should not be applied to the breasts of nursing mothers unless the mothers instructed to do so by the physician.
The aim of this article is to bring less well recognised adverse effects of inhaled corticosteroids to the attention of prescribers. Whilst inhaled steroids have a more favourable side effect profile than systemic steroids, they are not free from adverse effects. The dose of inhaled steroids used should be carefully monitored, and kept at the lowest dose necessary to maintain adequate control of the patient’s disease process. Be particularly aware of the cumulative effect of co-prescribing various dose forms of corticosteroids (inhaled, intranasal, oral and topical preparations).