Is it safe to take steroids (corticosteroids) during pregnancy?

Safety of Corticosteroids During Pregnancy

Certain corticosteroids can be safely used during pregnancy after the first trimester, with methylprednisolone and prednisolone being the preferred options due to their limited placental transfer. 1

Types of Corticosteroids and Pregnancy Safety

Topical/Intranasal Corticosteroids

• Modern nasal corticosteroids (budesonide, fluticasone, mometasone) are considered safe during pregnancy at recommended doses 2
• Minimal systemic absorption makes these options preferable when treating respiratory conditions during pregnancy
• Budesonide has the most extensive safety data and is FDA category B for pregnancy 2

Systemic Corticosteroids

• First trimester use:

  • Associated with increased risk of oral clefts in the fetus 1
  • Should be avoided unless absolutely necessary for maternal health

• Second and third trimester use:

  • Methylprednisolone or prednisolone are preferred due to significant metabolism in the placenta, limiting fetal exposure 1
  • Betamethasone and dexamethasone should be avoided as premedication due to almost 100% placental transfer 1
  • Short bursts of corticosteroids may be used for severe conditions after the first trimester 1

Indications and Recommendations

For Chemotherapy-Induced Nausea/Vomiting

• Methylprednisolone or prednisolone are the steroids of choice for managing chemotherapy-induced nausea and vomiting during pregnancy 1
• Should be used after 10 weeks gestation when the palate has already formed 1

For Respiratory Conditions

• Intranasal corticosteroids at recommended doses are preferred over systemic options 2
• Use the minimum effective dose to control symptoms 2
• Avoid unapproved formulations such as budesonide irrigations or nasal drops 2

For Musculoskeletal Conditions

• Non-systemic (local) steroid injections can be considered for pregnant women with musculoskeletal pain that doesn't respond to conservative measures 3
• Single-dose local administration appears to have no adverse effects on mother or baby 3

Monitoring During Steroid Use in Pregnancy

• Pregnant patients receiving chemotherapy or corticosteroids need additional ultrasounds (every 3-4 weeks) to document adequate fetal growth 1
• Fetal umbilical artery Doppler exams should be added in case of growth restriction 1
• Monitor for maternal hyperglycemia, especially with longer courses of corticosteroids 1
• Consultation with the patient's obstetrician is recommended before initiating steroid therapy 1

Risks and Precautions

• FDA classifies corticosteroids as Pregnancy Category C - animal studies have shown adverse effects, but potential benefits may warrant use despite risks 4

• Potential risks include:

  • Cleft palate (when used in first trimester) 1, 4
  • Preeclampsia 1
  • Premature birth and low birth weight 1, 5
  • Adrenal insufficiency in newborns (with substantial maternal doses) 4

• Benefits generally outweigh risks when treating severe maternal conditions, especially those that could impact pregnancy outcomes 5

Breastfeeding Considerations

• Very little corticosteroid enters breast milk 5
• The American Academy of Pediatrics considers oral steroids compatible with breastfeeding 1
• A decision should be made whether to discontinue nursing or the drug, considering the importance of the drug to the mother 4

Remember that the safety profile varies significantly between different corticosteroids and routes of administration. When steroids are clinically indicated during pregnancy, selecting the right type, timing, and route of administration is crucial to minimize fetal risk while effectively treating the maternal condition.