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 in the body and suppress the immune system. They can be given by mouth (orally), or injected, and this way, 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, and are also given to people who have a deficiency of natural corticosteroid hormones. Guidelines in the UK state that pregnant women with threatened preterm labour should be offered injected corticosteroids to help protect the baby’s lungs following early delivery. Corticosteroids are not the same as steroids used by bodybuilders.

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 on the body. 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.

Is it safe to use systemic corticosteroids in pregnancy?

There is no yes or no answer to this question as the requirement for a specific treatment varies from person to person and is dependent on factors such as the severity of the illness and the complications that could arise if treatment is altered or not given. When deciding whether to use systemic corticosteroids during pregnancy it is therefore important to weigh up how necessary they are to your health against any possible risks to you or your baby, some of which might depend on how many weeks pregnant you are.

It is important to appropriately treat conditions such as severe asthma and some auto-immune diseases in pregnancy. In some women, symptoms of auto-immune disease or asthma may improve as pregnancy progresses and a doctor might then advise that certain treatments can be reduced or stopped. For other women treatment with systemic corticosteroids throughout pregnancy might be considered the safest option for both mother and baby.

You should not alter the dose of any of your medicines without medical supervision, and you should not suddenly stop taking systemic corticosteroids as this can potentially cause life-threatening effects. Your doctor is the best person to help you decide what is right for you and your baby.

What if I have already used systemic corticosteroids during pregnancy?

If you have used any medicines it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether you still need the medicines that you are on and to make sure that you are taking the lowest dose that works.

Can using systemic corticosteroids in pregnancy cause my baby to be born with birth defects?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

In animal studies, exposure to systemic corticosteroids in the womb increased the risk of cleft lip and palate in baby rats, mice, and rabbits. It is therefore possible that this might also happen in humans, although seven of the nine studies that have been carried out in human pregnancy do not support this theory. However, there is not enough information from these studies to rule out that in certain situations, for example use of a high potency systemic corticosteroid or higher doses of corticosteroids in pregnancy may increase the risk of cleft lip and palate in the baby. More research into this subject is therefore required.

None of six studies that investigated the rates of heart defects in babies exposed in the womb to systemic corticosteroids found any increase in risk.

Two of the three studies that have investigated whether hypospadias (where the opening of the penis is on the underside rather than at the tip) is more common in male babies exposed in the womb to systemic corticosteroids have found no increased risk. However, because not all the studies agreed, more research into this subject is required.

Rates of other specific birth defects have not been studied in a large enough number of pregnant women who used systemic corticosteroids to allow an accurate assessment of risk. Further research into the rates of other birth defects following exposure to systemic corticosteroids in the womb is therefore required.

Can using systemic corticosteroids in pregnancy cause miscarriage?

Two of the three studies carried out so far have found that miscarriage was more likely among women using systemic corticosteroids in pregnancy. However, the possibility that the mothers underlying illnesses explained the higher occurrence of miscarriage was not accounted for. Well-designed studies that take into account underlying factors that can cause miscarriage are therefore required.

Can using systemic corticosteroids in pregnancy cause stillbirth?

Two of the three studies carried out so far have provided no evidence that women using systemic corticosteroids in pregnancy might be at increased risk of stillbirth. However, two of these studies, (including the one that did find possible evidence of an increased risk), did not use the most appropriate analysis techniques. Some of the conditions that steroids are used to treat can themselves increase the likelihood of stillbirth. Well-designed studies of the rates of stillbirth following use of systemic corticosteroids in pregnancy are therefore required.

Can using systemic corticosteroids in pregnancy cause preterm birth?

Five of the six studies carried out so far have shown that preterm delivery is more common in babies born to women who used systemic corticosteroids in pregnancy. However, preterm birth is more common in women with conditions such as severe asthma. In these studies it remained possible that the increased risk of preterm delivery was caused by the underlying illnesses in the mothers, rather than by corticosteroid treatment itself. Carefully designed studies of preterm birth rates following pregnancy exposure to systemic corticosteroids that account for the effects of the underlying illness in the mother are therefore required.

Can using systemic corticosteroids in pregnancy cause low birth weight in the baby?

Five studies provide no convincing evidence overall that use of systemic corticosteroids in pregnancy adversely affects the baby’s growth in the womb. However, these studies include less than 800 babies born to pregnant women using systemic corticosteroids, and further research into the effects of pregnancy exposure to systemic corticosteroids on fetal growth is therefore required to confirm this finding.

Can using systemic corticosteroids in pregnancy cause learning or behavioural problems in the child?

A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.

One small study found that children aged between six and 12 years who were exposed in the womb to a systemic corticosteroid (dexamethasone) were not at increased risk of learning and behavioural problems compared to children not exposed to systemic corticosteroids. However, larger studies into additional aspects of learning and behaviour are required, including studies of other individual corticosteroids, before we can say for sure that exposure to systemic corticosteroids in the womb does not affect learning and development.

Will my baby need extra monitoring during pregnancy?

As part of their routine antenatal care most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.

There is no evidence that using a systemic corticosteroid during pregnancy causes any problems that would require extra monitoring of your baby. However, pregnant women with some of the conditions that systemic corticosteroids are used to treat might receive extra monitoring during pregnancy to ensure that they remain healthy and that the baby is growing and developing as expected.

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

We would not expect any increased risk to your baby if the father used a systemic corticosteroid before or around the time you became pregnant.

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.  

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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