Steroids And Pregnancy: Weighing The Risks And Benefits

Steroids are a group of medications used to treat a variety of conditions, including asthma, autoimmune diseases, inflammatory bowel disease (IBD), and skin conditions. While steroids can be beneficial during pregnancy, there are potential risks and side effects that should be considered.

Some studies have linked the use of steroids during pregnancy to an increased risk of cleft lip or palate in newborns, premature delivery, and low birth weight. However, the evidence is conflicting, and the overall risks appear to be low. In people with IBD, for example, evidence shows that major birth defects are not likely, and the benefits of controlling IBD symptoms may outweigh the risks.

It is important to note that steroids should not be abruptly discontinued without consulting a healthcare provider. Pregnant individuals taking steroids should discuss any concerns with their obstetrician and a gastroenterologist, preferably one specializing in IBD and pregnancy. Additionally, steroids may be particularly beneficial for pregnant individuals with health problems like asthma, lupus, and skin disorders.

Side effects of steroid use during pregnancy can include increased hair growth, eye pain or vision problems, sore throat or cough, seizures or muscle twitching, and numbness or burning in the arms or legs. More serious side effects may also occur, such as confusion or vomiting, and require immediate medical attention.

Overall, while steroids may carry some risks during pregnancy, they are generally considered safe when prescribed by a healthcare provider and can be beneficial for managing certain health conditions.

Steroids and the placenta

The placenta is formed at the interface of maternal and foetal circulation. It plays a crucial role in the biosynthesis, metabolism, and regulated exchange of steroids between the mother and the foetus. Cholesterol, for example, is transported from the mother to the foetus, and it is also a precursor for placental progesterone and estrogen synthesis.

The placenta expresses multiple glucocorticoid receptor (GR) isoforms, which may be partially regulated by the 5' exon 1 GR gene promoter region. This region consists of 9 different promoters and 13 splice variants. In the context of steroid metabolism, the placenta can metabolise certain steroids. For instance, hydrocortisone is completely metabolised by the placenta within 24 hours, while dexamethasone is only partially metabolised.

In terms of steroid biosynthesis, the placenta was once believed to be incapable of converting pregnenolone and progesterone into androgen products. However, more recent studies have provided evidence of placental CYP17A1 mRNA expression, albeit at lower levels compared to other enzymes.

During pregnancy, steroids may be prescribed by a doctor or gynaecologist in specific situations, such as unexpected preterm labour or to manage pre-existing health conditions like asthma, bronchial infections, lupus, or skin problems. While steroids are generally considered safe during pregnancy, they should only be taken under medical supervision. The recommended dosage and timing of steroid administration during pregnancy can vary depending on the specific circumstances.

Steroids and cleft lip and palate

Steroids are a group of medications that help relieve swelling, redness, itching, and allergic reactions in the immune system. They are often prescribed to treat asthma, lupus, eczema, psoriasis, rheumatoid arthritis, inflammatory bowel disease, and skin disorders.

The use of steroids during pregnancy has been inconsistently associated with cleft lip and palate in newborns. Cleft lip and palate are one of the most common birth defects, affecting about 1.7 per 1,000 live births. They occur when the fusion of the lip and/or palate is disrupted during the first trimester of pregnancy.

Some studies have found a link between steroid use during pregnancy and cleft lip and palate in newborns. For instance, a 2017 review found that older studies reported an increased risk of oral clefts in newborns following steroid use during pregnancy. However, more recent studies have not supported these findings. Another study found that the risk of cleft lip with or without cleft palate was 1.7 times higher among infants born to mothers who used steroids during pregnancy.

On the other hand, several studies have found no association between steroid use during pregnancy and cleft lip and palate. A large population-based study from Denmark found no association between maternal corticosteroid use and cleft lip and palate in the offspring. Similarly, a 2011 nationwide cohort study from Denmark showed no clear link between mothers' use of corticosteroids early in pregnancy and the risk of oral clefts.

The conflicting evidence suggests that while steroid use during pregnancy may be associated with a small increase in the risk of cleft lip and palate, the overall risk is low. More research is needed to definitively determine the association between steroid use during pregnancy and cleft lip and palate.

Steroids and preterm birth

Steroids are often prescribed to pregnant women to help prevent preterm labour and reduce the risk of complications for the baby. Steroids can help the baby's lungs mature quickly, thus enabling them to cope with the outside atmosphere. They can also help develop the various organs and body parts of preemies faster.

Benefits of steroids in preterm birth

• Steroids can help the baby's lung mature quickly, thus enabling them to cope with the outside atmosphere.
• Steroids can help develop the various organs and body parts of preemies faster.
• Steroids can do wonders for women who have a history of miscarriage.
• Steroids can be particularly beneficial for pregnant women with health problems like asthma, lupus and skin disorders.
• Consuming steroids also lowers the risk of brain damage and Neonatal Respiratory Distress Syndrome (NRDS) in premature babies.
• The intestines of a preterm newborn are underdeveloped and weak. Therefore, steroids help in protecting the baby from intestinal infections and bowel issues.

Side effects of steroids in preterm birth

• Steroids can aggravate blood pressure.
• A condition called pulmonary oedema (water retention in the lungs) occurs if the person is taking steroids with medication to prevent preterm labour.
• A person with diabetes or gestational diabetes should not take steroids since it could increase the blood sugar levels.
• In some cases, babies born of mothers who took steroids during pregnancy weigh less when born.
• The risk of cleft lip is 6 times more in newborns when the mother takes steroids in the first trimester.
• Multiple doses of steroids during pregnancy can have a negative effect on fetal intrauterine growth.
• It can also result in a decrease of the foetal heart rate variation.
• Multiple doses of corticosteroid can cause an increase in infections like endometritis.

Recommended dosage of steroids in preterm birth

• In case of unexpected preterm labour, a minimum of two doses are given, 12 or 24 hours apart.
• If necessary, the dose may be repeated after it has been taken more than a week before.
• A doctor may suggest steroid weekly for a long duration. However, doctors suggest this in very rare cases.

Who can take steroids during preterm birth?

• Steroids can be prescribed to a pregnant woman if she has asthma or bronchial infections.
• If she has had recurrent miscarriages.
• If there were foetal abnormalities in her previous pregnancies.
• If preterm labour is imminent.

Who should not take steroids during preterm birth?

Women who suffer from diabetes or chorioamnionitis shouldn’t take steroids.

Steroids and low birth weight

Steroids are often prescribed to pregnant women to help treat asthma, inflammatory bowel disease (IBD), lupus, skin disorders, and certain types of arthritis and cancer. They are also used to treat pre-existing health conditions and to prevent preterm labour.

Pregnant women who take steroids are more likely to give birth to babies with low birth weight. This is especially true for women with severe IBD. However, it is unclear whether the reduced birth weight is directly caused by the drug or by the complications that led to the treatment.

In a 2019 study, researchers found an association between steroid treatment and reduced birth weight. They analysed data from 278,508 births in Finland and found that babies exposed to steroids were born with lower birth weights, whether they were preterm, near-term, or full-term. The weight difference was 220 grams for preterm babies, 141 grams for near-term babies, and 89 grams for full-term babies.

A 2017 review of studies also showed a small increase in the risk of a cleft lip with first-trimester corticosteroid use. However, steroid use this early in the pregnancy is uncommon.

A 2018 review found that older studies of prednisone use in pregnancy reported an increased risk of oral clefts in newborns. However, more recent studies have not replicated these findings.

In a 2010 study, researchers compared outcomes of extremely low birth weight infants exposed to no antenatal steroids, incomplete antenatal steroids, and a complete course of antenatal steroids at varying intervals prior to delivery. They found that mortality and intraventricular hemorrhage were significantly lower in the group that received a complete course of antenatal steroids.

A 2005 study published in The Journal of Allergy and Clinical Immunology found that women who took corticosteroids to treat asthma during pregnancy had babies with slightly lower birth weights than those who did not.

Steroids and gestational diabetes

Pregnant women with diabetes may be prescribed steroids, such as corticosteroids, to reduce harmful inflammation. However, steroids can also increase the risk of developing gestational diabetes, which is characterised by high blood glucose levels in pregnancy.

The benefits of steroids during pregnancy

Steroids, such as corticosteroids, are often prescribed to pregnant women to reduce harmful inflammation caused by the body's immune system. They are used to treat a number of illnesses, including asthma, autoimmune diseases, and skin conditions. They can also be used to treat pre-existing diabetes.

Steroids are also beneficial for pregnant women at risk of preterm delivery. They can help accelerate lung maturity in the preterm foetus, reducing the risk of respiratory distress and lowering the risk of hyaline membrane disease in preterm infants.

The risks of steroids during pregnancy

Steroids can increase the risk of gestational diabetes by increasing insulin resistance, allowing blood glucose levels to rise and remain higher. People on steroids who are already at a higher risk of type 2 diabetes or those who need to take steroids for longer periods of time are the most susceptible to developing steroid-induced diabetes.

In addition, the use of steroids during pregnancy has been associated with an increased risk of cleft lip and palate in newborns. There is also a risk of neonatal hypoglycaemia, which is associated with adverse neurodevelopmental outcomes.

Managing steroids and gestational diabetes

Pregnant women with diabetes who are prescribed steroids should closely monitor their blood glucose levels. In some cases, insulin therapy may be required to manage blood glucose levels.

Alternative treatments

Alternative treatments are available for pregnant women with diabetes. For example, non-steroidal anti-inflammatory drugs (NSAIDs) can be taken with caution during pregnancy, although they should be stopped at the beginning of a menstrual cycle when conception is planned.

While steroids can be beneficial for pregnant women with diabetes, they may also increase the risk of developing gestational diabetes. It is important for pregnant women with diabetes to closely monitor their blood glucose levels and work with their healthcare providers to manage their condition.

Frequently asked questions