Are corticosteroids (corticosteroid) safe during pregnancy?

From the Guidelines

Corticosteroids such as prednisone and budesonide can be safely used during pregnancy when medically necessary, with the lowest effective dose used for the shortest duration possible, as recommended by the most recent guidelines 1. When considering corticosteroid use during pregnancy, it is essential to weigh the benefits of treating serious maternal conditions against potential risks to the fetus.

• Key considerations include:
  • The type of corticosteroid used, with prednisone and budesonide being preferred options due to their minimal systemic absorption and lower risk of fetal exposure 1.
  • The dose and duration of treatment, with the goal of using the lowest effective dose for the shortest duration possible to minimize potential risks 1.
  • The condition being treated, with corticosteroids being essential for managing conditions like asthma exacerbations, autoimmune disorders, or inflammatory conditions during pregnancy 1. Some key points to consider when using corticosteroids during pregnancy include:
• Inhaled corticosteroids like budesonide are preferred for asthma management due to their minimal systemic absorption 1.
• Topical use of low to medium potency corticosteroids (like hydrocortisone 1-2.5%) is preferred over high-potency options 1.
• If corticosteroids are needed for fetal lung maturation, betamethasone (two 12 mg doses 24 hours apart) or dexamethasone (four 6 mg doses every 12 hours) are the standard regimens 1. It is crucial to note that the benefits of treating serious maternal conditions generally outweigh potential risks to the fetus, and corticosteroids can be a vital part of managing these conditions during pregnancy 1.
• The most recent guidelines recommend continuing low-dose glucocorticoid treatment (≤10 mg daily of prednisone or nonfluorinated equivalent) during pregnancy if clinically indicated, and tapering higher doses to <20 mg daily of prednisone, adding a pregnancy-compatible glucocorticoid-sparing agent if necessary 1.

From the FDA Drug Label

Usage in Pregnancy: Since adequate human reproduction studies have not been done with corticosteroids, the use of these drugs in pregnancy, nursing mothers or women of childbearing potential requires that the possible benefits of the drug be weighed against the potential hazards to the mother and embryo or fetus Infants born of mothers who have received substantial doses of corticosteroids during pregnancy, should be carefully observed for signs of hypoadrenalism. Pregnancy Teratogenic Effects Pregnancy Category C Corticosteroids have been shown to be teratogenic in many species when given in doses equivalent to the human dose Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring. There are no adequate and well-controlled studies in pregnant women. Corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus

The use of corticosteroids during pregnancy is not entirely safe and should be weighed against the potential hazards to the mother and fetus. Key points to consider include:

• The potential for teratogenic effects, as seen in animal studies
• The lack of adequate and well-controlled studies in pregnant women
• The need to carefully observe infants born to mothers who have received substantial doses of corticosteroids during pregnancy for signs of hypoadrenalism
• The importance of weighing the potential benefits against the potential risks to the fetus 2 3.

From the Research

Corticosteroid Use in Pregnancy

• Systemic corticosteroids are not teratogenic, and pregnant women receiving corticosteroid therapy suffer the same side effects and benefits as do treated women who are not pregnant 4.
• Clinical experience suggests no abnormalities of children of mothers treated with usual doses of prednisone and methylprednisolone throughout pregnancy, but premature rupture of amniotic membranes and low birthweight babies may occur 4.
• Betamethasone and dexamethasone are used to treat the fetus, and very little corticosteroid ingested by the mother enters her breast milk 4.

Safety of Topical Corticosteroids

• Most studies found no causal associations between maternal exposure to topical corticosteroids of any potency and pregnancy outcomes, including mode of delivery, congenital abnormalities, preterm delivery, fetal death, and low Apgar score 5.
• However, there is a possible association between low birth weight and maternal use of potent to very potent topical corticosteroids, especially when the cumulative dosage of topical corticosteroids throughout the pregnancy is very large 5.
• Mild to moderate topical corticosteroids may have a protective effect on fetal death, but this finding needs further investigation 5.

Antenatal Corticosteroid Therapy

• Antenatal corticosteroid therapy is standard care for women at risk of preterm birth before 34 weeks of gestation, and it improves neonatal outcomes by maturing fetal pulmonary function 6, 7.
• However, there are concerns about the potential negative long-term consequences of antenatal corticosteroids, especially for the exposed fetus who was born beyond the period of greatest benefit 8.
• A single course of antenatal corticosteroids is recommended, but repeated courses may be necessary in some cases, and the benefits and risks of antenatal corticosteroid therapy need to be carefully considered 6, 8.