Are corticosteroids safe for pregnant women with rheumatoid arthritis (RA)?

Updated: May 11, 2018
  • Author: Katherine K Temprano, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

Corticosteroids are potent anti-inflammatory agents. They are considered relatively safe in pregnancy when used in low doses and are designated as category B medications. Nonetheless, corticosteroids may increase the maternal risk of hypertension, edema, gestational diabetes, osteoporosis, premature rupture of membranes, and small-for-gestational-age babies. [22]

One meta-analysis found a 3.5-fold increase in the risk of cleft palate in fetuses with first-trimester exposure to corticosteroids. [23]

The choice of glucocorticoid depends on whether the mother or the fetus needs to be treated. Hydrocortisone and cortisone cross the placenta, but 11 beta-dehydrogenase, a placental enzyme, converts hydrocortisone to cortisone, which is biologically inactive; thus, the fetus is exposed to only approximately 10% of the maternal dose. [24] Therefore, if steroid treatment is desired for the mother, hydrocortisone, cortisone, or prednisone should be chosen.

Dexamethasone and betamethasone cross the placenta with similar maternal and fetal concentrations; thus, they are the treatment of choice for fetal respiratory distress.

The lowest possible steroid dose needed to control disease activity should be used in pregnancy. Stress doses of steroids should be used during labor and delivery if the mother received steroids (even low-dose) for more than 2-3 weeks during pregnancy, and the neonate should be monitored for evidence of adrenal insufficiency and infection.


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