USE OF SYSTEMIC CORTICOSTEROIDS IN PREGNANCY

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(Date of issue: December 2016, Version: 1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

Corticosteroids are a class of hormones produced in the adrenal cortex which are involved in a range of physiological functions. Exogenous corticosteroids are commonly used to reduce inflammation, suppress the immune system, and to replace hormones in the body where a deficiency exists. During pregnancy, where premature delivery is anticipated, corticosteroids may be administered to the mother to reduce the risk of respiratory distress syndrome in the neonate. Systemic corticosteroids available in the UK include: prednisolone, prednisone, hydrocortisone, betamethasone, dexamethasone, deflazacort, methylprednisolone and triamcinolone.

Systemic administration of corticosteroids has been associated with an increase in rates of cleft lip and palate in some animal models. Although the majority of data do not suggest that gestational exposure to systemic corticosteroids increases the risk of orofacial clefts in human offspring, a small number of studies have suggested an association and further research is therefore required. The available data do not support an association between in utero exposure to systemic corticosteroids and cardiac defects in the offspring. Data on other specific malformations are too limited to confirm or refute associations. Studies assessing birth weight outcomes following gestational exposure to systemic corticosteroids (low birth weight, intrauterine growth restriction, small for gestational age) do not provide robust evidence of an association, but are limited. The currently available data suggest that preterm delivery may be associated with gestational exposure to systemic corticosteroids. However, they do not rule out that this may be due to confounding as a consequence of the underlying maternal illness, rather than to steroid exposure itself, and further well-controlled studies are required to address this question. Due to limited data it is not currently possible to conduct an evidence-based assessment of the risks of spontaneous abortion, intrauterine death, and adverse neurodevelopmental outcomes in the child following gestational exposure to systemic corticosteroids. It should also be borne in mind that many of the studies reporting pregnancy outcomes following gestational exposure to systemic corticosteroids are limited by a lack of stratification to account for differing doses, treatment duration, and steroid potencies. An increased risk of adverse fetal effects following use of high dose/potency corticosteroids, or use for extended periods, can therefore not be ruled out.

Where use of systemic corticosteroids is clinically indicated for mother or fetus, treatment should not be withheld on account of pregnancy. Exposure to corticosteroids at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.