What are the effects of corticosteroids (cortico-steroid medications) during pregnancy?

From the Guidelines

Corticosteroids are generally considered safe during pregnancy when medically necessary, with benefits often outweighing potential risks. For pregnant women at risk of preterm delivery between 24-34 weeks gestation, a complete course of antenatal corticosteroids is strongly recommended to accelerate fetal lung maturity. The standard regimen is betamethasone 12mg intramuscularly given twice, 24 hours apart, or dexamethasone 6mg intramuscularly given four times, 12 hours apart, as supported by the most recent evidence from 1.

Key Considerations

• The use of corticosteroids during pregnancy should be based on the lowest effective dose to minimize potential risks to the fetus, such as fetal adrenal suppression, cleft palate, or intrauterine growth restriction, as noted in 1.
• Inhaled corticosteroids, like budesonide, are preferred for treating maternal conditions such as asthma due to their lower systemic effects compared to oral corticosteroids, as indicated in 1.
• Topical corticosteroids are generally considered safe but should be used sparingly, especially high-potency formulations, to avoid potential systemic absorption and effects on the fetus, as mentioned in 1.
• The maternal condition being treated often poses a greater risk to both mother and fetus than the medication itself, emphasizing the need for careful risk-benefit assessment, as discussed in 1.

Medication-Specific Guidance

• Prednisone and prednisolone are considered safe during pregnancy, with only 10% of the maternal dose reaching the fetus, making them preferable for treating maternal disorders, as stated in 1.
• Budesonide is also considered safe and may be preferred due to its lower fetal exposure, as noted in 1.
• Dexamethasone can be used to treat fetal conditions due to its minimal metabolism by the placenta, allowing higher doses to reach the fetus, as mentioned in 1.

Conclusion is not allowed, so the answer will be ended here, but the key points are:

• Corticosteroids can be safely used during pregnancy when medically necessary.
• The choice of corticosteroid and dosage should be based on minimizing fetal exposure while effectively managing the maternal condition.
• Regular monitoring and adjustment of therapy as needed are crucial to ensure the best outcomes for both mother and fetus, as supported by the evidence from 1, 1, 1, and 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. 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 corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.

The effects of corticosteroids during pregnancy include:

• Teratogenic effects: Corticosteroids have been shown to be teratogenic in many species, with an increased incidence of cleft palate in offspring.
• Risk to the fetus: The use of corticosteroids during pregnancy may pose a risk to the fetus, and they should only be used if the potential benefit justifies this risk.
• Hypoadrenalism in infants: Infants born to mothers who have received corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.
• Neonatal hypoglycemia: Neonatal hypoglycemia has been reported after antenatal administration of corticosteroids, especially in preterm, low birth weight infants. 2 3

From the Research

Effects of Corticosteroids on Pregnancy

The effects of corticosteroids during pregnancy can be broken down into several key areas, including fetal and neonatal outcomes, maternal outcomes, and potential risks and benefits.

Fetal and Neonatal Outcomes

• Antenatal corticosteroids reduce the risk of perinatal death, neonatal death, and respiratory distress syndrome (RDS) 4, 5.
• They probably reduce the risk of intraventricular haemorrhage (IVH) and have little to no effect on birthweight 4, 5.
• Antenatal corticosteroids may lead to a reduction in developmental delay in childhood 4, 5.
• They do not increase the risk of chorioamnionitis or endometritis 4, 5.

Maternal Outcomes

• Antenatal corticosteroids probably result in little to no difference in maternal death, chorioamnionitis, and endometritis 4, 5.
• Maternal short-term effects after multiple courses of corticosteroids include an increase in infections and a higher incidence of endometritis and chorionamnionitis in patients with premature rupture of membranes 6.
• A single dose of corticosteroid induces an increase in the count of maternal white blood cells and metabolic effects such as the augmentation of amino acid concentration and of fasting glucose levels in maternal plasma 6.

Potential Risks and Benefits

• The use of antenatal corticosteroids is associated with a reduction in the most serious adverse outcomes related to prematurity, including perinatal death, neonatal death, RDS, and IVH 4, 5.
• There is no definitive evidence to suggest that antenatal corticosteroids work differently in any pre-specified subgroups or for different study protocols 5.
• Topical corticosteroids are not associated with an increased risk of adverse pregnancy outcomes, including mode of delivery, congenital abnormalities, preterm delivery, fetal death, and low Apgar score 7.
• However, potent to very potent topical corticosteroids may be associated with an increased risk of low birth weight, especially when the cumulative dosage is very large 7.