Prednisone And Pregnancy

Pregnancy is marked by a state of physiological and hormonal imbalance that affects physical, emotional and psychological aspects of maternal health and wellbeing. But most importantly, a higher degree of caution and care is needed to create the optimum environment for fetal growth and development, which includes minimizing exposure to drugs, chemicals and medications during pregnancy, due to risk of placental transmission and accumulation of these agents in the developing baby.

The FDA has categorized drugs into various classes in order to ensure maternal and fetal health. Prednisone - a very popular anti-inflammatory drug - is labeled a Class C drug, suggesting possible risk of fetal harm if consumed during pregnancy. Healthcare providers have varying opinions about the administration of this drug during different trimesters; however, several animal and human experiments did confirm that prednisone is capable of crossing the placental barrier after oral administration.

Why Pregnant Mothers May Need Prednisone During Pregnancy

Traditionally, it is recommended to avoid any drug during pregnancy, but it has been observed that certain chronic medical conditions can be exacerbated by pregnancy, and this is especially true for systemic lupus erythematosus, severe and uncontrolled asthma, and rheumatoid arthritis. In addition, certain procedures like organ transplantation require persistent consumption of prednisone to prevent the risk of transplant rejection.

G. Ruiz-Irastorza^[1] conducted research to evaluate the risk of developing SLE flares during pregnancy. He identified that approximately 65% of pregnant women developed flares that were similar in severity to pre-pregnancy flares and were most frequently reported during the second and third trimesters of pregnancy.

Is Prednisone Contraindicated During Pregnancy?

Prednisone is not contraindicated during pregnancy; however, there is consensus among healthcare providers that it is best to minimize the use of prednisone during pregnancy, unless there is a life-threatening situation, such as status asthmaticus - an acute emergency complication of asthma that responds very well to prednisone.

Investigators have identified certain factors that may help in minimizing the risk of drug concentration in the fetus, and these are:

• Dose adjustment or modification can minimize the risk of fetal complications.
• Administration by inhalation is less hazardous than oral intake.
• Choosing prednisone and prednisolone is a better and safer option when compared to betamethasone and dexamethasone that are similar in terms of site of action.

It is noteworthy that in certain situations, especially when premature birth is expected, in situations such as twin pregnancies or maternal gestational diabetes, glucocorticoids can be safely given to mothers in the later stages of pregnancy to improve fetal lung maturity in case of premature birth. Prednisone is a glucocorticoid too, but in these situations, other analogs like betametasone or dexamethasone are preferred due to high bioavailability and transfer to the fetus via the placenta.

Long-Term Consequences of Administering Prednisone to Pregnant Mothers

Prednisone complications are primarily classified as:

Maternal Complications:

The complications of long-term therapy with prednisone are the same in pregnant and non- pregnant females and include^[5]:

• Immunosuppression that is marked by a higher propensity to develop viral, bacterial and fungal infections.
• Weakening of bones due to changes in serum concentration and metabolic changes. The osteoporosis may lead to pathological fractures and osteopenia, and the effects may be even worse because of pregnancy-related changes in the serum calcium.
• Onset of hypertension, further complicating pregnancy and fetal growth.
• Hyperglycemia or higher risk of developing gestational diabetes mellitus.
• Other complications include cataracts, abdominal striae, increased pregnancy-related weight gain, premature rupturing of membranes and higher risk of infections after childbirth.
• It has also been observed that pregnancy and delivery is more complicative in mothers who consume prednisone throughout the pregnancy. Likewise, cesarean sections are also associated with higher morbidity and complications.

Fetal Complications:

The risk of complications and adverse effects is fairly high in pregnant mothers, and therefore, most healthcare providers and investigators avoid prophylactic administration of prednisone to expectant mothers with a known history of chronic medical conditions. According to a case study^[2], a baby born to a mother who consumed prednisone during pregnancy, for chronic renal disease, developed following complications within 10 weeks post-birth:

• Abnormal functioning of the thymus - the primary organ responsible for immunological functioning of the human body after birth.
• Low serum concentration of lymphocytes and low serum level of immunological proteins.
• At 10 weeks, the baby developed cytomegalovirus infection (CMV).
• At 1 year, the baby presented with another episode of CMV and low IgA concentration^[2].

It is ideally recommended that prednisone be avoided during pregnancy, unless there are stronger potential benefits than possible adverse effects. Additionally, all babies who were exposed to prednisone therapy or immunosuppression during pregnancy must be evaluated soon after childbirth for possible infections and complications.

References:

1. Ruiz-Irastorza, G., Lima, F., Alves, J., Khamashta, M. A., Simpson, J., Hughes, G. R. V., & Buchanan, N. M. M. (1996). Increased rate of lupus flare during pregnancy and the puerperium: a prospective study of 78 pregnancies. Rheumatology, 35(2), 133-138.
2. Cot, C. J., Meuwissen, H. J., & Pickering, R. J. (1974). Effects on the neonate of prednisone and azathioprine administered to the mother during pregnancy. The Journal of pediatrics, 85(3), 324-328.
3. GREENBERGER, P. A., & PATTERSON, R. (1983). Beclomethasone diproprionate for severe asthma during pregnancy. Annals of Internal Medicine, 98(4), 478-480.
4. Bermas, B. L., & Hill, J. A. (1995). Effects of immunosuppressive drugs during pregnancy. Arthritis & Rheumatism, 38(12), 1722-1732.
5. Janssen, N. M., & Genta, M. S. (2000). The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Archives of internal medicine, 160(5), 610.