ASK DIS: 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:

ASK DIS