Pregnancy glucocorticoids

The first point is that treatment with steroids is generally palliative rather than curative, and only in a very few diseases, such as leukemia and nephrotic syndrome, do corticosteroids alter prognosis. One must also consider which is worse, the disease to be treated or possible induced hypercortisolism. The patient s age can be an important factor, since such adverse effects as hypertension are more apt to occur in old and infirm individuals, especially in those with underlying cardiovascular disease. Glucocorticoids should be used with caution during pregnancy. If steroids are to be employed, prednisone or prednisolone should be used, since they cross the placenta poorly. 

Osteonecrosis of the femoral head can occur with glucocorticoids in nonpregnant individuals, but has not previously been reported in pregnancy (376). 

However, first trimester in utero exposure to a glucocorticoid was associated with a small risk of major neonatal malformations, according to the results of a Canadian meta-analysis (383). Six cohort studies and one case-control study were analysed, and the results showed that women who had taken long-term glucocorticoid therapy during pregnancy were more likely to have a baby with a major malformation than women who had not (OR = 2.46 95% Cl = 1.41, 4.29). 

A hydatidiform mole during pregnancy may have been due to the glucocorticoids used in an immunosuppressive regimen (385). 

Retardation of intrauterine growth by glucocorticoids has been reported not only in animals but also in man. In a 1990 case from France, dwarfism (as well as Cushing s syndrome) was recorded in a child whose mother had received high-dose glucocorticoids during pregnancy. 

There are no firm data on the use of corticotropin in pregnancy both glucocorticoid and androgenic effects might be expected to affect the fetus. 

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