Oral and injected (systemic) corticosteroids

Date: July 2023, Version 2.0

Quick read

Systemic corticosteroids can be used in pregnancy if recommended by a doctor.

What are they?

Systemic corticosteroids (prednisolone, prednisone, hydrocortisone, betamethasone, dexamethasone, deflazacort, methylprednisolone and triamcinolone) are used to treat auto-immune disease and other conditions linked to inflammation, such as severe eczema and asthma. They are also used to prevent the rejection of transplanted organs.

A corticosteroid injection may be offered to women who show signs that their baby will be born prematurely. This is to speed up development of the baby’s lungs, so that the baby is less likely to need help with breathing after birth.

Systemic corticosteroids are also used to treat severe COVID-19 infection.


What are the benefits of using a systemic corticosteroid in pregnancy?

Corticosteroids reduce inflammation by stopping the immune system from attacking the body’s tissues. This is important to reduce unpleasant symptoms and prevent long-term damage. It may also lower the chance of some pregnancy problems linked to uncontrolled inflammation, including miscarriage and lower birth weight.


Are there any risks of using a systemic corticosteroid in pregnancy?

Corticosteroid use in early pregnancy has been linked in some (but not all) studies to a higher chance of having a baby with a cleft lip and/or palate. However, it is clear that the vast majority of babies exposed in the womb to systemic corticosteroids are born without these conditions.

Women taking a systemic corticosteroid in pregnancy may have a higher chance of having a preterm birth. However, it is thought likely that at least some of this effect is due to the underlying inflammatory conditions in these women which have themselves been linked to preterm birth.


Are there any alternatives to using a systemic corticosteroid in pregnancy?

Possibly. Other medicines can often be used to treat inflammatory conditions during pregnancy. However, systemic corticosteroids are usually considered to be among the safest options and are often recommended as a first-choice medicine to treat rheumatic and auto-immune disease during pregnancy.

Some women may find that their symptoms improve during pregnancy; if so, their specialist may advise that their medicine(s) can be altered. However, women should not change or stop their medication without speaking to their doctor.

Women who are planning a pregnancy should speak to their specialist to determine which medicine is best. This can be arranged through the GP or specialist clinic.

If a woman becomes pregnant while taking a systemic corticosteroid she should be reviewed by her doctor as soon as possible.

No treatment

What if I prefer not to take a systemic corticosteroid during pregnancy?

It is important that inflammatory conditions are well-treated during pregnancy in order to avoid a flare-up of symptoms and to reduce the chance of certain pregnancy complications. Similarly, preventing rejection of a transplanted organ is vital to the health of the woman and her baby. A doctor will be happy to discuss any concerns.

Will I or my baby need extra monitoring?

As part of routine antenatal care in the UK, women are invited for a very detailed scan at around 20 weeks of pregnancy to check the baby’s development. No further scans to check for birth defects will be required due to use of a systemic corticosteroid. However, women with inflammatory illnesses or a transplanted organ will usually be offered closer monitoring during pregnancy, including extra scans of the baby’s growth in the third trimester.

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

There is currently no evidence that a systemic corticosteroid used by the father can harm the baby through effects on the sperm.

Who can I talk to if I have questions?

If you have any questions regarding 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

How can I help to improve drug safety information for pregnant women in the future?

Our online reporting system (MyBump Portal) allows women who are currently pregnant to create a secure record of their pregnancy, collected through a series of questionnaires. You will be asked to enter information about your health, whether or not you take any medicines, your pregnancy outcome and your child's development. You can update your details at any time during pregnancy or afterwards. This information will help us better understand how medicines affect the health of pregnant women and their babies. Please visit the MyBump Portal to register.

General information
Sadly, miscarriage and birth defects can occur in any pregnancy.

Miscarriage occurs in about 1 in every 5 pregnancies, and 1 in every 40 babies are born with a birth defect. This is called the ‘background risk’ and happens whether medication is taken or not.

Most medicines cross the placenta and reach the baby. For many medications this is not a problem. However, some medicines can affect a baby’s growth and development.

If you take regular medication and are planning to conceive, you should discuss whether your medicine is safe to continue with your doctor/health care team before becoming pregnant. If you have an unplanned pregnancy while taking a medicine, you should tell your doctor as soon as possible.

If a new medicine is suggested for you during pregnancy, please make sure that the person prescribing it knows that you are pregnant. If you have any concerns about a medicine, you can check with your doctor, midwife or pharmacist.

Our Bumps information leaflets provide information about the effects of medicines in pregnancy so that you can decide, together with your healthcare provider, what is best for you and your baby.