Can a pregnant woman be given methylprednisolone?

Methylprednisolone Use During Pregnancy

Methylprednisolone can be administered to pregnant women when clinically indicated, particularly for severe, refractory maternal disease, but should be used cautiously with the lowest effective dose due to potential maternal-fetal complications. 1

Safety Profile and Recommendations

Methylprednisolone is considered a viable treatment option during pregnancy in several clinical scenarios:

• For severe, refractory maternal disease: IV methylprednisolone pulses are considered among the safest options for treating severe maternal disease during pregnancy 1
• For hyperemesis gravidarum: Can be given as a last resort in patients with severe hyperemesis gravidarum (16 mg IV every 8 hours for up to 3 days, followed by tapering over 2 weeks) 1
• For management of acute asthma: Intravenous methylprednisolone is recommended for acute asthma during pregnancy 2

Timing Considerations

The timing of methylprednisolone administration during pregnancy is important:

• First trimester concerns: Administration in the first trimester has been reported to slightly increase the risk of cleft palate when given before 10 weeks of gestation, though data have been conflicting 1
• After 10 weeks: There are fewer concerns since the palate has been formed by this time 1

Dosing Considerations

• Lowest effective dose: Use the lowest effective dose to minimize maternal and fetal risks 1
• Duration: Limit maximum duration to 6 weeks when possible 1
• Maintenance dose: For chronic conditions, taper to ≤5 mg/day (prednisolone equivalent) when possible 1

Maternal Risks

Prolonged use or higher doses of methylprednisolone during pregnancy may lead to:

• Pregnancy-associated osteoporosis
• Gestational diabetes (screening recommended) 1
• Serious maternal infections
• Preterm birth 1
• Hypertension and preeclampsia 1

Fetal/Neonatal Risks

• Adrenal suppression: Can occur in newborns when mothers receive high-dose methylprednisolone, especially in late pregnancy 3, 4
• Low birth weight: Has been associated with antenatal steroid use 4
• Cleft palate: Slightly increased risk when used before 10 weeks gestation 1

Monitoring Recommendations

1. Maternal monitoring:

   • Screen for gestational diabetes mellitus 1
   • Monitor for hypertension and preeclampsia
   • Watch for signs of infection

2. Fetal monitoring:

   • Additional ultrasounds (every 3-4 weeks) to document adequate fetal growth 1
   • Consider fetal umbilical artery Doppler exams if growth restriction occurs 1

3. Neonatal monitoring:

   • Observe newborns for signs of adrenal suppression, particularly if mother received high doses in late pregnancy 3
   • Monitor for hypoglycemia and electrolyte abnormalities 4

Comparison to Other Corticosteroids

• Preferred corticosteroids: Methylprednisolone or prednisolone are preferred over dexamethasone or betamethasone during pregnancy 1
• Placental metabolism: Prednisolone and methylprednisolone are highly sensitive to placental enzyme 11 beta-hydroxy steroid dehydrogenase type 2, which limits fetal exposure 4
• Fetal exposure: Dexamethasone and betamethasone cross the placenta more readily and should be reserved for when fetal treatment is the goal 4

Clinical Pitfalls and Caveats

• Adrenal suppression: Women taking >5 mg prednisolone per day for more than 3 weeks are at increased risk of adrenal suppression and may need increased glucocorticoid dose at delivery 1
• Hyperemesis gravidarum: Parenteral glucocorticoid replacement may be needed if women have severe hyperemesis gravidarum 1
• Breastfeeding: Very little corticosteroid ingested by the mother enters breast milk, making it compatible with breastfeeding 5
• FDA labeling: The FDA notes that "the use of these drugs in pregnancy requires that the possible benefits of the drug be weighed against the potential hazards to the mother and embryo or fetus" 6

In summary, while methylprednisolone carries some risks during pregnancy, it can be administered when clinically indicated, particularly for severe maternal disease, with appropriate monitoring and precautions.