Can Injectable Hydrocortisone Be Given to a Pregnant Woman?
Yes, injectable hydrocortisone can be safely administered to pregnant women when clinically indicated, as glucocorticoids during pregnancy carry no additional risk for mother and child. 1
Safety Profile During Pregnancy
Hydrocortisone is FDA pregnancy category B and is not teratogenic in humans at therapeutic doses. 2, 1
The spectrum of adverse effects in pregnant patients does not differ from non-pregnant patients, though pregnant women have baseline increased risk for conditions like osteoporosis, diabetes, and hypertension that overlap with corticosteroid side effects. 2, 1
Hydrocortisone is preferred over dexamethasone or betamethasone for maternal conditions because it is extensively metabolized by the placenta, resulting in only 10% of the maternal dose reaching the fetus. 1
When Injectable Hydrocortisone Is Indicated
Adrenal Insufficiency Management
During delivery in patients with adrenal insufficiency, 100 mg hydrocortisone should be administered intravenously at the onset of active labor, followed by either continuous infusion of 200 mg/24 hours or 50 mg intramuscularly every 6 hours. 1
After uncomplicated delivery, rapid tapering over 1-3 days to the regular replacement dose is appropriate. 1
Patients with primary adrenal insufficiency may require small dose adjustments during pregnancy, particularly in the last trimester. 1
Perioperative Management
All patients on glucocorticoid therapy for longer than 1 month who undergo surgery need perioperative management with adequate hydrocortisone replacement to overcome potential adrenal insufficiency. 2
For major surgery during pregnancy, 100 mg of hydrocortisone intravenously before anesthesia and every 8 hours for 4 doses thereafter is recommended, with gradual tapering by half per day afterwards. 2, 1
For moderate physical stress-inducing procedures, a single dose of 100 mg of hydrocortisone intravenously has been proposed. 2
Acute Severe Conditions
Intravenous methylprednisolone (or hydrocortisone as an alternative) is recommended for acute severe asthma during pregnancy. 3
Severe gestational conditions requiring systemic corticosteroids should be treated at the lowest effective dosage. 3
Critical Pitfalls to Avoid
Do not discontinue necessary hydrocortisone therapy due to pregnancy concerns—the risk of uncontrolled maternal disease typically exceeds any theoretical fetal risk. 1
Do not confuse hydrocortisone with dexamethasone or betamethasone, which cross the placenta more readily and should not be used for maternal conditions. 1
Do not forget stress-dose coverage during labor and delivery in patients on chronic corticosteroid therapy, as this can precipitate adrenal crisis. 1
Monitor pregnant patients on any corticosteroid for gestational diabetes, as corticosteroids can impair glucose tolerance. 4
Fetal Safety Evidence
High doses of corticosteroids have been associated with low birth weight in humans, and animal models have shown cleft palate, but standard therapeutic doses have not demonstrated these effects in humans. 2, 1
The incidence of infection was not increased in neonates who had been exposed to glucocorticoids in utero. 2
Recent multicenter data documented no maternal or neonatal fatality in pregnant women with adrenal insufficiency receiving hydrocortisone replacement. 5
Fetal adrenal function appears unaffected by corticosteroids and they are unlikely to contribute to adverse effects on fetal growth and development. 6
Breastfeeding Compatibility
Hydrocortisone is excreted minimally into breast milk, and breastfeeding by women on low-dose therapy is generally considered safe. 1
Infant exposure can be minimized by avoiding breastfeeding during the first 4 hours after hydrocortisone intake, when equilibrium between milk and serum concentrations is highest. 1