From the Guidelines
Prednisone and prednisolone are considered safe to use during pregnancy when medically necessary, as they have a low risk of adverse effects on the fetus and are preferred for treating maternal disorders. According to the most recent and highest quality study 1, glucocorticoids such as prednisone and prednisolone are compatible with pregnancy and have a low risk of birth defects. The study also notes that the lowest effective dose should be used to minimize potential risks.
Some key points to consider when using steroids during pregnancy include:
- The specific medication, dosage, and route of administration used
- The trimester of pregnancy
- The potential risks and benefits of treatment
- The need to minimize exposure to the fetus
Other steroids, such as betamethasone and dexamethasone, are specifically used to help fetal lung development when preterm birth is anticipated 1. Topical steroids of low to moderate potency, such as hydrocortisone 1% or triamcinolone 0.1%, are typically safe for localized skin conditions 1.
It's also important to note that anabolic steroids, used for muscle building, should be completely avoided during pregnancy as they can cause serious harm to the developing fetus. The American Association for the Study of Liver Diseases recommends that glucocorticoids be used at the lowest effective dose and that patients be closely monitored for potential adverse effects 1.
In terms of breastfeeding, glucocorticoids are excreted minimally into breast milk, and breastfeeding by women on low-dose glucocorticoid therapy is generally considered to be safe 1. However, it's recommended to delay breastfeeding for 3-4 hours after the dose to minimize transfer to breast milk.
Overall, the use of steroids during pregnancy should be carefully considered and monitored by a healthcare provider to minimize potential risks and ensure the best possible outcomes for both the mother and the fetus.
From the Research
Steroid Use During Pregnancy
- The use of systemic corticosteroids during pregnancy is not teratogenic, and pregnant women receiving corticosteroid therapy experience the same side effects and benefits as non-pregnant women 2.
- Clinical experience suggests that prednisone and methylprednisolone are safe to use during pregnancy, but may increase the risk of premature rupture of amniotic membranes and low birthweight babies 2.
- Betamethasone and dexamethasone are used to treat the fetus, and very little corticosteroid ingested by the mother enters her breast milk 2.
Specific Steroids and Their Safety
- Prednisone is considered safe to use during pregnancy, and low doses of prednisone or prednisolone (10 mg daily or 5 mg bid) can control most inflammatory features of early polyarticular rheumatoid arthritis 3.
- Dexamethasone is also used to treat asthma exacerbations, and there is no convincing evidence of differences in outcomes between higher and lower doses of dexamethasone or between dexamethasone and prednisolone 4.
- Topical ophthalmic corticosteroids, such as those used to treat allergic conjunctivitis, are not significantly associated with an increase in congenital anomalies, preterm birth, low birthweight, or composite outcome 5.
Precautions and Considerations
- Corticosteroid therapy in pregnancy should be used to control clinically active maternal illness, treat an in utero infant suffering from neonatal lupus-associated carditis, or induce fetal lung maturation 2.
- Adrenal insufficiency is a potential risk of long-term glucocorticoid treatment, and patients receiving low-dose prednisolone treatment should be monitored for adrenal function 6.
- The use of corticosteroids during pregnancy should be carefully considered and monitored by a healthcare provider to minimize potential risks and side effects.