Use of Corticosteroid In Acute Asthma in Pregnancy

• Prednisolone has been assigned to pregnancy category C by the FDA.
• Some animal studies have revealed evidence of fetal harm, although data are conflicting
• No controlled data in human pregnancy
• Is only recommended for use during pregnancy when there are no alternatives and benefit outweighs risk

Evidence of Cases Reported

• In the Michigan Medicaid Birth Defects Study involving 229,101 pregnancies from 1985 to 1992, there were 143 first trimester exposures to prednisolone
• A statistically significant increase in the total number of birth defects was found, with eleven cases reported compared with only six cases expected.
• However, no association between prednisolone and the six categories of defects studied (cardiovascular, oral clefts, spina bifida, polydactylies, limb reduction defects/syndactylies, hypospadias) was found

Oral Glucocorticosteroid

• Because of their importance in the treatment of a variety of inflammatory conditions, systemic glucocorticoids have been used fairly extensively during pregnancy
• However, it is difficult to exclude an adverse pregnancy effect due to asthma in studies of patients with asthma symptoms severe enough to require oral glucocorticoids.
• potential gestational risks of oral glucocorticoids must be balanced against the risks to the mother or the infant of inadequately treated disease.
• risks of severe uncontrolled disease are generally considered to be the greater risk, suggesting that oral glucocorticoids should still be used when indicated

Inhaled Glucocorticosteroid

•  In contrast to oral/systemic glucocorticoids, the safety data on inhaled glucocorticoids are reassuring
• One study assessed 84 pregnant women who were managed with or without inhaled beclomethasone after discharge following an asthma hospitalization during pregnancy . Use of this medication significantly decreased the rate of readmission for asthma (12 versus 33 percent), and no adverse events or outcomes were reported

References:

1. www.uptodate.com
2. http://www.drugs.com/pregnancy/prednisolone.html