What is the role of Prednisone (corticosteroid) in managing asthma exacerbation during pregnancy?

From the Guidelines

Prednisone is recommended for treating asthma exacerbations during pregnancy when indicated, as the benefits of treating maternal asthma exacerbations clearly outweigh potential risks. The standard dosing is typically 40-60mg daily for 5-7 days, with no taper needed for short courses 1. This medication crosses the placenta but has been used safely in pregnancy for decades. Untreated asthma poses greater dangers to both mother and fetus through hypoxemia. While there is a small increased risk of cleft palate with first-trimester exposure, this risk is minimal compared to the dangers of uncontrolled asthma 1.

Some key points to consider when using prednisone in pregnancy include:

• Maintaining asthma control during pregnancy is crucial for the health and well-being of both the mother and her baby 2
• Uncontrolled asthma increases the risk of perinatal mortality, pre-eclampsia, preterm birth, and low-birth-weight infants 2
• Patients should continue their regular controller medications during and after the prednisone course
• If symptoms aren't improving with oral steroids, prompt medical evaluation is necessary as hospitalization with IV steroids and additional treatments may be required
• The goal is to maintain normal maternal oxygenation to ensure adequate fetal oxygen supply, as poorly controlled asthma during pregnancy is associated with preterm birth, low birth weight, and increased perinatal complications 3, 4, 2

It is essential to weigh the potential risks and benefits of prednisone use in pregnancy, considering the severity of the asthma exacerbation and the potential consequences of uncontrolled asthma on both the mother and the fetus 1. The use of prednisone in pregnancy should be guided by the principle of using the lowest effective dose for the shortest duration necessary to control symptoms.

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.

Prednisone use in pregnancy for asthma exacerbation should be carefully considered, as corticosteroids have been shown to be teratogenic in animal studies.

• The potential benefit of using prednisone to manage an asthma exacerbation in pregnancy must be weighed against the potential risk to the fetus.
• Close monitoring of the infant for signs of hypoadrenalism is recommended if prednisone is used during pregnancy.
• No adequate and well-controlled studies have been conducted in pregnant women to fully understand the risks and benefits of prednisone use in this population 5.

From the Research

Asthma Exacerbation in Pregnancy

• Asthma is a common comorbidity during pregnancy, with up to 45% of women experiencing exacerbations, resulting in poor outcomes for mothers and babies, including low birth weight and preterm delivery 6.
• The goals of effective asthma management in pregnancy are to maintain the best possible asthma control and prevent exacerbations, which can be achieved by using preventer medications, managing comorbid conditions, and maintaining fetal oxygenation 6, 7.

Treatment Options

• Guidelines recommend the continued use of inhaled corticosteroids (ICSs) in pregnancy, with budesonide having a particularly good safety profile 7.
• Oral corticosteroids (OCSs), such as prednisone, may be required for severe exacerbations, but their use should be carefully monitored due to potential risks to the mother and fetus 7, 8.
• Inflammation-based management, which adjusts treatment according to markers of airway inflammation, has been shown to be effective in reducing exacerbations in pregnancy and may also improve perinatal outcomes 6, 7.

Management Strategies

• Regular monitoring of symptoms and adjustment of treatment as needed is crucial to prevent exacerbations and ensure the best possible outcomes for mother and baby 6, 7, 9.
• A multidisciplinary approach, involving obstetricians, pulmonologists, and other healthcare professionals, can help to optimize asthma management and improve perinatal outcomes 7, 9.
• Identifying and managing comorbidities, such as rhinitis, cigarette smoking, obesity, and mental health issues, is also important to ensure effective asthma management during pregnancy 7, 9.