Taking Steroids During Pregnancy – Is It Safe?

Steroids during pregnancy may sound alarming, but they are generally considered safe when used under medical supervision. Expecting mothers can take steroids (only on prescription) for various pre-existing health conditions such as asthma, lupus, and certain skin problems. These medications are often prescribed by a doctor when she feels there is a risk of the pregnant woman going into preterm labor. In such cases, the use of steroids helps in the accelerated development of the baby’s lungs, brain, and intestines, which is crucial for the baby’s survival and health. Steroids are particularly beneficial for lung maturity, ensuring the baby can breathe more easily if born prematurely.

Why Do Steroids Become Necessary During Pregnancy?

In early pregnancy, steroids are usually given for treating recurring miscarriages or foetal abnormalities. Doctors often prescribe steroid drugs known as corticosteroids for preterm labour. Babies born before the full term (i.e. 37th week) are at risk of respiratory distress and death due to underdeveloped lungs. The use of steroids expedites the development of the lungs of preterm babies and increases their chances of survival. Steroids also lower the risk of brain haemorrhage and a serious bowel disorder called necrotizing enterocolitis (NEC) in premature babies.

How Do Steroids Help a Pregnant Woman?

Steroids are believed to have numerous benefits during pregnancy. Some of them are mentioned below –

• Steroids can help the baby’s lung mature quickly, thus enabling his lungs to cope with the outside atmosphere.
• Steroids can help develop the various organs and body parts of preemies faster.
• They can do wonders for women who have a history of miscarriage.
• steroids can particularly be 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.

What Is the Recommended Dosage?

Steroids are deemed to be safe for a pregnant woman if they are prescribed to her by her gynaecologist. The recommended dosage of steroids for a pregnant woman in different situations can be the following –

• 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?

Steroids can be prescribed to a pregnant woman in the following cases –

• 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.

In the above cases, steroids may be given anytime between the 24th and the 36th week of pregnancy.

Who Shouldn’t Take Steroids?

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

Side Effects of Taking Steroids During Pregnancy

There are two sides to a coin. Here are some side effects of taking steroids:

• Steroids 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.

FAQs

1. How soon do steroids start working during pregnancy?

Steroids generally start working within 24 hours of the first dose and have the most significant impact between 24 to 48 hours after the second dose. This rapid response is crucial in promoting the baby’s lung development in cases of impending preterm labor.

2. Can steroids be used in all trimesters of pregnancy?

Are you wondering about the administration of steroids in the first, second and third trimesters? Steroids are generally prescribed in the later stages of pregnancy, particularly in the third trimester, when preterm labor is a risk. They are rarely used in the first trimester unless absolutely necessary, as this is a critical period for fetal organ development.

3. Is there a risk of developing Cushing’s syndrome from steroid use during pregnancy?

Cushing’s syndrome is a rare condition that can develop from prolonged or excessive steroid use. However, the short-term use of steroids prescribed during pregnancy, especially for lung maturity or other critical conditions, rarely leads to this syndrome. Close medical supervision ensures the dosage remains safe for both mother and baby.

This was all about steroids while pregnant. Antenatal steroids (ANS) like corticosteroids have a lot many benefits; they have been successful in saving many preterm babies from the claws of death. However, the use of steroids during pregnancy can also have serious and long-lasting effects on the baby and the mother. Also, check with your doctor regarding topical steroids during pregnancy. So, never take this medication without a prescription.

References/Resources:

1. Antenatal Corticosteroid Therapy for Fetal Maturation; American College of Obstetricians and Gynecologists Clinical; https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/antenatal-corticosteroid-therapy-for-fetal-maturation

2. Asztalos. E, Willan. A, Murphy. K, Matthews. S, et al.; Association between gestational age at birth, antenatal corticosteroids, and outcomes at 5 years: multiple courses of antenatal corticosteroids for preterm birth study at 5 years of age (MACS-5) (BMC Pregnancy and Childbirth); National Library of Medicine; https://pmc.ncbi.nlm.nih.gov/articles/PMC4261573/; August 2014

3. Crowther. C, McKinlay. C, Middleton. P, Harding. J; Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes (Cochrane Library); National Library of Medicine; https://pmc.ncbi.nlm.nih.gov/articles/PMC7104525/; July 2015

4. McGoldrick. E, Stewart. F, Parker. R, Dalziel. S; Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth (Cochrane Library); National Library of Medicine; https://pmc.ncbi.nlm.nih.gov/articles/PMC8094626/; December 2020

5. Mwansa-Kambafwile. J, Cousens. S, Hansen. T, Lawn. J; Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth (International Journal of Epidemiology); Oxford Academic; https://academic.oup.com/ije/article/39/suppl_1/i122/702274; March 2010

6. Räikkönen. K, Gissler. M, Tapiainen. T, Kajantie. E; Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children (JAMA Network); National Library of Medicine; https://pmc.ncbi.nlm.nih.gov/articles/PMC9403777/; August 2022

7. Roberts. D, Brown. J, Medley. N, Dalziel. S; Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth (Cochrane Library); National Library of Medicine; https://pmc.ncbi.nlm.nih.gov/articles/PMC6464568/; March 2017

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