From the Guidelines
Corticosteroids can be administered during pregnancy for headache management, but with caution and careful consideration of the potential risks and benefits.
Key Considerations
- The use of corticosteroids during pregnancy has been studied in various contexts, including the management of preterm labor 1 and rheumatic diseases 1.
- Prednisolone and prednisone are considered safe in pregnancy, but high doses may be associated with low birth weights and cleft palate in experimental animal models 1.
- The risk of congenital malformations with corticosteroid use in the first trimester of pregnancy is uncertain, with some studies suggesting an increased risk of isolated cleft lip ± cleft palate, as well as increased risk of pre-term delivery, low birthweight, and pre-eclampsia 1.
- The benefits of corticosteroids in severe headache management may outweigh the potential fetal risks, but the lowest effective dose should be used to minimize exposure to the fetus 1.
Specific Corticosteroids
- Prednisolone is considered safe in pregnancy, but high doses may be associated with adrenal insufficiency in the newborn 1.
- Prednisone is possibly safe in pregnancy, but conflicting data suggest a potential increased risk of congenital malformations and pre-term delivery 1.
- Budesonide and beclomethasone are preferred inhaled corticosteroids during pregnancy due to their lower risk of congenital malformations and pre-term delivery 1.
From the Research
Administration of Corticosteroids During Pregnancy for Headache Management
- The use of corticosteroids during pregnancy for headache management is a complex issue, and the decision to administer them should be made on a case-by-case basis, considering the potential benefits and risks 2, 3, 4.
- According to a study published in 2017, the preferred therapeutic strategy for the treatment of primary headaches during pregnancy and breastfeeding should always be a non-pharmacological one, and medication should only be used if non-pharmacological interventions seem inadequate 2.
- A 2021 study found that long-term corticosteroid use during pregnancy is associated with increased maternal and neonatal adverse outcomes, including preeclampsia, preterm premature rupture of membranes, pyelonephritis, and venous thromboembolisms 3.
- Another study published in 2021 discussed the management of chronic headache and migraine during pregnancy, emphasizing the importance of maximizing non-pharmacological options and using the smallest number of safest medicines at the lowest effective doses 5.
- A 1998 study on corticosteroids during pregnancy found that systemic corticosteroids are not teratogenic, but premature rupture of amniotic membranes and low birthweight babies may occur, and that corticosteroid therapy in pregnancy is appropriate to control clinically active maternal illness 4.
- It is essential to weigh the potential benefits of corticosteroid therapy against the potential risks and to closely monitor patients who receive corticosteroids during pregnancy 3, 4.