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Corticosteroids are commonly used to treat inflammatory diseases. There is conflicting evidence regarding the association of corticosteroid use in pregnancy and congenital malformations in offspring. We conducted a prevalence study of 83,043 primiparous women who gave birth to a live-born singleton in northern Denmark, in 1999–2009. Through medical registries, we identified prescriptions for corticosteroids, congenital malformations, and covariates. Furthermore, we summarized the literature on this topic. Overall, 1449 women (1.7%) used inhaled or oral corticosteroids from 30 days before conception throughout the first trimester. Oral cleft in the offspring was recorded for 1 of the users (0.08%) and 145 of the nonusers (0.2%), prevalence odds ratio (OR) 0.47 [95% confidence interval (CI), 0.07–3.34]. The prevalence OR for congenital malformations overall was 1.02 (95% CI, 0.79–1.32). According to published studies, the use of corticosteroids in early pregnancy was associated with congenital malformations overall with relative estimates ranging from 0.8 (95% CI, 0.4–1.7) to 2.1 (95% CI, 0.5–9.6). For oral clefts, the ORs ranged from 0.6 (95% CI, 0.2–1.7) to 5.2 (95% CI, 1.5–17.1). We found no evidence of an association between use of corticosteroids in early pregnancy and risk of congenital malformations in offspring.