Is dexamethasone safe to use during pregnancy?

From the Guidelines

Dexamethasone can be used during pregnancy when medically necessary, but it should be prescribed and monitored by a healthcare provider. It is generally considered safe for specific indications such as promoting fetal lung maturity when preterm delivery is anticipated, treating maternal conditions like severe asthma, or managing certain pregnancy complications. However, dexamethasone should not be used routinely during pregnancy due to potential risks. Long-term or high-dose use may be associated with side effects including increased risk of maternal gestational diabetes, hypertension, and potential effects on fetal growth. When used for fetal lung maturity, the benefits typically outweigh the risks as it significantly reduces respiratory distress syndrome and mortality in premature infants. The medication works by accelerating the production of surfactant in the fetal lungs, which helps keep air sacs open after birth. Any pregnant woman prescribed dexamethasone should discuss the specific benefits and risks for her situation with her healthcare provider, as recommended by the Society for Maternal-Fetal Medicine 1. High-dose dexamethasone or betamethasone should be given as per national guidance to improve fetal lung maturity if a pregnancy complicated by certain conditions is to be delivered before 35 weeks’ gestation 1. It is essential to weigh the benefits and risks of dexamethasone use in pregnancy, considering the potential for neurocognitive and neurosensory disorders in the offspring during childhood, as noted in the EASL clinical practice guidelines 1. Ultimately, the decision to use dexamethasone during pregnancy should be made on a case-by-case basis, taking into account the individual patient's needs and medical history. Key considerations include:

• The specific indication for dexamethasone use
• The potential benefits and risks of treatment
• The gestational age and fetal development
• The patient's medical history and underlying conditions
• The availability of alternative treatments or therapies. By carefully evaluating these factors and consulting with a healthcare provider, pregnant women can make informed decisions about the use of dexamethasone during pregnancy.

From the FDA Drug Label

Usage in Pregnancy Since adequate human reproduction studies have not been done with corticosteroids, use of these drugs in pregnancy or in women of childbearing potential requires that the anticipated benefits be weighed against the possible 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.

The use of dexamethasone during pregnancy requires careful consideration of the potential benefits and risks. Key points to consider:

• There is a lack of adequate human reproduction studies with corticosteroids.
• The anticipated benefits of using dexamethasone during pregnancy must be weighed against the possible hazards to the mother and the embryo or fetus.
• Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be monitored for signs of hypoadrenalism. Given the lack of clear evidence on the safety of dexamethasone in pregnancy, caution is advised when using this medication in pregnant women 2.

From the Research

Dexamethasone Safety in Pregnancy

• The safety of dexamethasone in pregnancy is a topic of ongoing research, with some studies suggesting potential benefits and others highlighting potential risks 3, 4, 5, 6.
• Dexamethasone is commonly used to promote fetal lung maturity and reduce neonatal respiratory distress syndrome in preterm births 3, 4.
• However, some studies have raised concerns about the potential adverse effects of prenatal dexamethasone exposure on fetal development, including osteoarthritis, hypertension, fatty liver, glomerulosclerosis, depression, diabetes, and infertility 5.
• A study published in 1984 found that maternal administration of dexamethasone in severe pregnancy-induced hypertension did not appear to be contraindicated, but noted that careful selection and monitoring of patients is necessary 4.
• Another study published in 2022 suggested that prenatal dexamethasone exposure could lead to adverse consequences on fetal organ systems, but noted that the evidence in humans is preliminary and limited by small sample size 5.
• Animal studies have also been conducted to investigate the effects of dexamethasone on fetal development, including a study on rats that found that dexamethasone exposure caused severe adrenosuppression 6.
• It is worth noting that dexamethasone has been used in veterinary medicine to terminate unwanted pregnancy in dogs, but this is not directly relevant to human pregnancy 7.

Key Findings

• Dexamethasone may be beneficial in promoting fetal lung maturity and reducing neonatal respiratory distress syndrome in preterm births 3, 4.
• However, potential adverse effects on fetal development, including osteoarthritis, hypertension, fatty liver, glomerulosclerosis, depression, diabetes, and infertility, have been raised 5.
• Careful selection and monitoring of patients is necessary when using dexamethasone in pregnancy 4.
• More research is needed to fully understand the effects of dexamethasone on fetal development and to confirm the findings of existing studies 5.