Steroid Use During Early Pregnancy: Safety Concerns and Guidelines

Medication during pregnancy: corticosteroids?

Hello Doctor: My wife has been regularly visiting the immunology department due to her condition (ankylosing spondylitis with iritis) and is currently 4 to 5 weeks pregnant.
This week, she experienced some bleeding, and we are concerned that her immune system might be attacking the embryo.
In addition to visiting the obstetrics and gynecology clinic, she also returned to the immunology department.
The immunologist prescribed her 5 mg of dexamethasone, a corticosteroid.
The doctor mentioned that this medication would not cross the placenta, but after researching online, the manufacturer's information indicates that it does cross the placenta, which is somewhat concerning.
I would like to ask the doctor if this type of corticosteroid could have an impact during early pregnancy.
Is taking three tablets a day too much? Thank you.

Lin Xiansheng, 30~39 year old female. Ask Date: 2019/08/01

Dr. Huang Jianzhong reply Obstetrics and Gynecology

My spouse has been regularly visiting the immunology department due to ankylosing spondylitis complicated by iritis.
She is currently 4 to 5 weeks pregnant and has experienced some bleeding this week, which raises concerns about the immune system attacking the embryo.
In addition to visiting the obstetrics and gynecology clinic, she also returned to the immunology department.
The immunologist prescribed 5 mg of dexamethasone, a corticosteroid.
The physician mentioned that this medication does not cross the placenta, but after researching online, the manufacturer's information indicates that it does cross the placenta, which is somewhat concerning.
I would like to ask the physician if this type of corticosteroid medication could have an impact during early pregnancy.
Also, considering the dosage of three tablets a day, is that too much? The response was that it should be fine.

Reply Date: 2019/08/01

More Info

The use of steroids during early pregnancy is a topic that raises significant safety concerns and requires careful consideration. In your case, your healthcare provider has prescribed hydrocortisone, a corticosteroid, to manage your condition related to spondyloarthritis and iritis. It is understandable to have concerns about the potential effects of this medication on your pregnancy, especially given the conflicting information you may have encountered online.

Corticosteroids, including hydrocortisone, are classified as Category C drugs by the FDA. This classification indicates that while animal studies have shown some adverse effects, there are no well-controlled studies in pregnant women. Therefore, the potential benefits of using the medication must be weighed against the risks. In many cases, corticosteroids are prescribed during pregnancy when the benefits to the mother outweigh the potential risks to the fetus.

Regarding your specific concerns about hydrocortisone passing through the placenta, it is true that corticosteroids can cross the placental barrier. However, the degree to which they affect fetal development largely depends on the dosage and duration of treatment. Low doses of hydrocortisone, such as the 5 mg you mentioned, are generally considered to be safe when prescribed for specific medical conditions. The key is to use the lowest effective dose for the shortest duration necessary to manage your symptoms.

In your situation, the fact that you are experiencing bleeding is understandably alarming. It's crucial to communicate this symptom to both your obstetrician and your immunologist. They can monitor your condition closely and determine if any adjustments to your treatment plan are necessary. It's also important to consider that bleeding in early pregnancy can occur for various reasons, not all of which are related to medication use.

If you are taking three tablets of hydrocortisone daily, this amounts to a total of 15 mg per day. While this is a moderate dose, it is essential to ensure that this dosage is appropriate for your specific medical condition. Your healthcare provider should regularly assess your need for this medication and make adjustments as necessary.

In summary, while there are concerns regarding steroid use during early pregnancy, the decision to use hydrocortisone should be based on a thorough evaluation of your medical needs and the potential risks involved. It is crucial to maintain open communication with your healthcare providers, report any concerning symptoms, and follow their guidance closely. If you have further questions or concerns about your treatment, do not hesitate to reach out to your healthcare team for clarification and support. Your health and the health of your baby are of utmost importance, and your providers are there to help you navigate this complex situation.

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