Steroids in pregnancy

• corticosteroids vary with respect to their ability to cross the placenta; dexamethasone and betamethasone cross the placenta readily while 88% of prednisolone is inactivated as it crosses the placenta (1)
  • use of corticosteroids for prolonged periods or repeatedly in pregnancy is associated with intra-uterine growth retardation (IUGR) in the foetus
  • no evidence of an increased incidence of IUGR following short-term treatment, such as prophylactic treament for neonatal respiratory distress syndrome
  • no convincing evidence that systemic corticosteroids cause an increased risk of congenital abnormalities such as cleft lip or palate
    
    
• a single course of antenatal corticosteroids is considered the standard of care for pregnant individuals between 24 and 34 weeks of gestation at risk of preterm delivery to prevent neonatal respiratory distress syndrome (2)
  
  
  
  • a nationwide cohort study found that children exposed to one course of antenatal corticosteroids were significantly more likely to have an increased risk of serious infection during the first 12 months of life (2)
    • one course of antenatal corticosteroids was significantly associated with a 1.2-1.7-fold increased risk of overall serious infection, sepsis, pneumonia, and acute gastroenteritis during the first 12 months of life
      
      
  • in a systematic review of both population based studies and randomised controlled trials, about 40% of infants were born at term after exposure to early antenatal corticosteroids (low/very low certainty) (3)
    • early exposure to steroids was associated with increased risks of admission to neonatal intensive care, intubation, hypoglycaemia requiring treatment, reduced anthropometric measurements, and increased long term neurodevelopmental or cognitive risks (low/very low certainty)
• using oral or parenteral corticosteroids (steroids) during breastfeeding
  • seek expert advice
  • recommended oral or parenteral (injected) corticosteroids of choice during breastfeeding include beclometasone, budesonide, hydrocortisone, methylprednisolone and prednisolone (4)
  • amounts of prednisolone in breastmilk are very low (5)
  • although it is often recommended to avoid breastfeeding for 4 hours after a dose this maneuver is not necessary because prednisolone milk levels are very low (5)
  • high doses might occasionally cause temporary loss of milk supply (5)

Reference:

1. Current Problems in Pharmacovigilance (1998), 24, 9.
2. Yao T, Chang S, Wu C, Tsai Y, Sheen K, Hong X et al. Association between antenatal corticosteroids and risk of serious infection in children: nationwide cohort study BMJ 2023; 382 :e075835 doi:10.1136/bmj-2023-075835
3. Ninan K, Gojic A, Wang Y, Asztalos E V, Beltempo M, Murphy K E et al. The proportions of term or late preterm births after exposure to early antenatal corticosteroids, and outcomes: systematic review and meta-analysis of 1.6 million infants BMJ 2023; 382 :e076035 doi:10.1136/bmj-2023-076035
4. NHS Specialist Pharmacy Service (July 2023).Using oral or parenteral corticosteroids during breastfeeding
5. Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Prednisolone. [Updated 2023 Apr 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501076/