From the Guidelines
Prednisone can be used during pregnancy when medically necessary, but should be prescribed at the lowest effective dose for the shortest duration possible. While corticosteroids like prednisone do cross the placenta, they are generally considered relatively safe during pregnancy, particularly compared to the risks of leaving serious maternal conditions untreated 1. The medication is commonly used to manage conditions such as asthma, autoimmune disorders, and inflammatory diseases during pregnancy.
Key Considerations
- Short-term use carries minimal risk, but prolonged use of high doses (typically over 20mg daily for extended periods) may potentially increase risks of complications like gestational diabetes, preeclampsia, premature rupture of membranes, and low birth weight 1.
- First trimester use has been associated with a small increased risk of cleft lip/palate, though this risk remains quite low in absolute terms 1.
- If you're pregnant and need prednisone, your healthcare provider will carefully weigh the benefits of treatment against potential risks, adjusting the dosage to find the minimum effective amount, with a conditional recommendation to continue low-dose glucocorticoid treatment (≤10 mg daily of prednisone or nonfluorinated equivalent) during pregnancy if clinically indicated 1.
Important Recommendations
- Never stop taking prescribed prednisone suddenly, as this can cause serious health problems, especially during pregnancy.
- For higher doses of nonfluorinated glucocorticoids, tapering to <20 mg daily of prednisone and adding a pregnancy-compatible glucocorticoid-sparing agent if necessary is strongly recommended 1.
From the FDA Drug Label
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 Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.
Pregnancy Safety: Prednisone is classified as a Pregnancy Category C medication, meaning it should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
- Key Points:
- Corticosteroids have been shown to be teratogenic in animal studies.
- There are no adequate and well-controlled studies in pregnant women.
- Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism. 2
From the Research
Pregnancy Safety on Use of Prednisone
- The use of prednisone during pregnancy has been studied in various research papers, with some indicating that it may be safe when used at low doses 3, 4.
- A study published in 2018 found that patterns of higher prednisone dose were associated with shorter gestational length compared to lower dose in pregnant women with rheumatoid arthritis 3.
- Another study from 1998 suggested that systemic corticosteroids, including prednisone, are not teratogenic and can be used during pregnancy to control clinically active maternal illness, but may increase the risk of premature rupture of amniotic membranes and low birthweight babies 4.
- The American College of Obstetricians and Gynecologists (ACOG) recommends that the decision to use any agent during pregnancy should be based on the clinical context, risks associated with individual medications, and gestational age 5.
- A study on the pharmacokinetics of prednisone during pregnancy and lactation found that prednisone and its metabolite, prednisolone, exhibit dose- and concentration-dependent pharmacokinetics during pregnancy, and infant exposure to these agents via breast milk is minimal 6.
- The use of prednisone in rheumatoid arthritis has been well established, and clinical trials have changed its clinical use, particularly with regards to dosage, with low-dose schemes being used more frequently 7.
- Overall, the available evidence suggests that prednisone can be used during pregnancy, but it is essential to carefully consider the benefits and risks, as well as the clinical context and gestational age 3, 4, 5, 7, 6.