Oral and injected (systemic) corticosteroids

(Date: December 2016. Version: 1)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

What are they?

Corticosteroids are a group of medicines that reduce inflammation and dampen the immune response. When they are taken by mouth (orally), or injected, the whole body is exposed to the medicine. This type of exposure is called ‘systemic’ exposure.

Systemic corticosteroids are mainly used to treat asthma and autoimmune disease, or to prevent rejection of a transplanted organ. They are also given to people with Addison’s disease, a potentially serious condition where the body does not make adequate quantities of natural corticosteroids. Guidelines in the UK state that pregnant women with threatened preterm labour should be offered injected corticosteroids to help protect the baby’s lungs if they are born early.

The most commonly used oral corticosteroid is prednisolone. Other corticosteroids that are taken orally or injected include betamethasone, deflazacort, dexamethasone, hydrocortisone, methylprednisolone, prednisone, and triamcinolone. Corticosteroids differ in terms of the strength of their effects. The medical term for this is steroid potency. The more potent a steroid is, the stronger its effects will be. For example, dexamethasone is more potent than prednisolone. A small amount of a potent steroid may therefore have a similar effect as a larger dose of a weaker steroid.

What are the benefits of using systemic corticosteroids in pregnancy?

Systemic corticosteroids may be prescribed short-term to control the symptoms associated with some allergic and inflammatory conditions. This type of use can prevent complications (such as those caused by severe asthma) and improve quality of life. For other medical conditions, longer-term use may be required to prevent serious complications such as tissue damage caused by an auto-immune disease, or rejection of a transplanted organ. When weighing up the possible risks and benefits of taking a systemic corticosteroid, it is worth bearing in mind that research has shown that in women with an autoimmune disease or a transplanted organ, appropriate use of medications that suppress the immune system is linked to better pregnancy outcomes.

Continued use of a systemic corticosteroid during pregnancy is vital for women with Addison’s disease to prevent serious ill health caused by a lack of natural corticosteroids in the body.

Are there any risks of using systemic corticosteroids during pregnancy?

Although early animal studies suggested that corticosteroid exposure in the womb may cause cleft lip and palate, the majority of human studies do not support this finding.  While this is reassuring, no studies have accurately investigated outcomes in pregnant women only using potent corticosteroids and further research is therefore required.

Some studies have shown that women taking a systemic corticosteroid in pregnancy may have a higher chance of miscarriage or preterm delivery. However, this is thought to be at least partly explained by the fact that some of the health conditions that systemic corticosteroids are used to treat have themselves been linked to a higher chance of these pregnancy outcomes. Overall, there is no convincing evidence that corticosteroid use in pregnancy directly causes miscarriage or preterm delivery.

Are there any alternatives to using systemic corticosteroids in pregnancy?

Possibly. Depending on the underlying condition that is being treated, there may be different (non-corticosteroid) medicines that can be used. Additionally, some inflammatory and autoimmune conditions improve on their own in pregnancy due to changes in the immune system, meaning that a treatment may no longer be needed.

Women using systemic corticosteroids who are planning a pregnancy or become pregnant should consult their doctor or specialist so that their medication can be reviewed. Please do not stop taking a systemic corticosteroid, or alter the dose, unless you have been advised to do so by your doctor or specialist.

What if I prefer not to take medicines during pregnancy?

Depending on the underlying medical condition, continuing either a systemic corticosteroid or a different medication during pregnancy may be advised to avoid serious complications. Your doctor will only prescribe medicines when absolutely necessary and will be happy to talk to you about any concerns that you might have.

Will my baby need extra monitoring?

As part of routine antenatal care, most women will be offered a very detailed scan at around 20 weeks of pregnancy to check the baby’s development. Women who have used a systemic corticosteroid in early pregnancy will not usually need any extra monitoring.

Are there any risks to my baby if the father has used a systemic corticosteroid?

There is currently no evidence that systemic corticosteroids used by the father around the time of conception can harm the baby.

Who can I talk to if I have questions?

If you have any questions about the information in this leaflet, please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org

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General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

   

www.medicinesinpregnancy.org

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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