Is prednisone (corticosteroid) safe to use in a patient at 9 weeks gestation?

From the Guidelines

Prednisone can be used during pregnancy, including at 9 weeks gestation, when the benefits outweigh the risks. For maternal conditions requiring corticosteroid treatment, prednisone is generally considered safe at the lowest effective dose for the shortest duration possible, as indicated by the American Association for the Study of Liver Diseases 1. Typical dosing ranges from 5-60 mg daily depending on the condition being treated. While there is a possible association with oral clefting, this risk is relatively low compared to the risks of leaving serious maternal conditions untreated. The placenta partially metabolizes prednisone to less active forms, reducing fetal exposure to about 10% of maternal levels.

Key Considerations

• The American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases conditionally recommends continuing low-dose glucocorticoid treatment (≤10 mg daily of prednisone or nonfluorinated equivalent) during pregnancy if clinically indicated 1.
• Non-fluorinated corticosteroids like prednisone and prednisolone are preferred over dexamethasone or betamethasone during early pregnancy as they cross the placenta less readily.
• Patients should not discontinue prescribed prednisone suddenly, as this could worsen their underlying condition and potentially harm both mother and fetus.
• For acute conditions, short courses (5-10 days) pose minimal risk, and for chronic conditions requiring ongoing therapy, regular monitoring of maternal response and fetal growth is recommended.

Safety and Monitoring

• The safety of prednisone during pregnancy has been evaluated, and while there is a small increased risk of cleft palate with first-trimester exposure, this risk is relatively low compared to the risks of leaving serious maternal conditions untreated 1.
• Glucocorticoids during pregnancy have no additional risk for mother and child, according to EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases 1.
• The incidence of infection was not increased in neonates who had been exposed to GCs in utero, and GCs are excreted minimally into breast milk, making breastfeeding by women on low-dose GC-therapy generally considered to be safe.

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

The use of prednisone in a patient at 9 weeks gestation is not recommended unless the potential benefit justifies the potential risk to the fetus. Pregnancy Category C indicates that corticosteroids have been shown to be teratogenic in animal studies, and there are no adequate and well-controlled studies in pregnant women. Therefore, prednisone should be used with caution and only if the potential benefit outweighs the potential risk to the fetus 2.

From the Research

Safety of Prednisone in Pregnancy

• There is no direct evidence in the provided studies regarding the safety of prednisone use in a patient at 9 weeks gestation.
• The studies focus on the use of corticosteroids and other medications in various conditions such as asthma and rheumatoid arthritis, but do not specifically address their use during pregnancy 3, 4, 5, 6, 7.
• However, it is known that corticosteroids like prednisone can be used in pregnancy for certain medical conditions, but their use should be carefully considered and monitored due to potential risks to the mother and fetus.

General Use of Corticosteroids

• Corticosteroids are commonly used to treat various conditions, including asthma and rheumatoid arthritis 4, 5, 6, 7.
• The use of corticosteroids can have significant benefits, but also carries potential risks and side effects, particularly with long-term use 4, 7.
• In some cases, corticosteroids may be used in conjunction with other medications, such as azathioprine, to achieve a therapeutic effect 5, 6.

Pregnancy-Related Considerations

• Exercise during pregnancy has been shown to have numerous benefits and is considered safe for both mother and fetus, but the use of medications like prednisone requires careful consideration 3.
• There is a need for careful evaluation and monitoring when using any medication during pregnancy to minimize potential risks to the mother and fetus.