A Review of Systemic Corticosteroid Use in Pregnancy and the Risk of Select Pregnancy and Birth Outcomes

Abstract

Synopsis The evidence to date regarding corticosteroid exposure in pregnancy and select pregnancy and birth outcomes is limited and inconsistent. Here we provide a narrative review of published literature summarizing the findings for oral clefts, preterm birth, birth weight, preeclampsia and gestational diabetes mellitus. Whenever possible, the results are limited to oral or systemic administration with a further focus on use in autoimmune disease. Although previous studies of corticosteroid exposure in pregnancy reported an increased risk of oral clefts in the offspring, more recent studies have not replicated these findings. Further, most of the literature lacks robust statistical analysis accounting for underlying disease or disease activity. The evidence to date suggests that first trimester corticosteroid use may confer a small increase in the odds of cleft lip with or without cleft palate, although data are conflicting and it is unknown to what extent the underlying maternal disease may contribute. There is little support that systemic corticosteroid use in pregnancy independently causes increases in risks of preterm birth, low birth weight, or preeclampsia. There is not sufficient evidence to determine whether corticosteroids could contribute to gestational diabetes mellitus.

Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group

“…[68][69][70][71] Corticosteroids can also be utilized as an adjunctive therapy for disease flares, but are avoided for maintenance therapy, owing to increased risks for preterm birth, low birthweight, or gestational diabetes. 72,73 Antimicrobials are reserved as an acute intervention for patients with pouchitis or perianal disease. 74 Loperamide (limited human data, question of cardiovascular defects) and diphenoxylate (limited human data, no associated risk) are common antidiarrheals used for IBD and should be discontinued when possible.…”

Myasthenia gravis and pregnancy

“…It has been inconsistently reported to be associated with increased risk of cleft lip/palate and use of lowest possible dose during pregnancy is recommended. 8,14,15 Medications that may be used with caution include azathioprine (AZA) and anti-calcineurins. Use of AZA has not been associated with reduced fertility or increased risk of congenital malformations.…”

Machine learning on drug-specific data to predict small molecule teratogenicity

“…In contrast, similar analysis of “YES” clusters reveals three teratogenic chemomarkers, including corticosteroids, fluoroquinolones, and acetylproline derivatives. While fluoroquinolones are documented teratogens 75–78 , there is contention on the toxicity of steroid derivatives 79–81 , as well as prolinated compounds 82–84 . Our model adds to this discussion by arguing that steroid derivatives are indeed teratogenic.…”