Cortisone, a type of corticosteroid, is a medication frequently used to manage various inflammatory and autoimmune conditions. Many expectant mothers wonder about the safety of using such medications during pregnancy. Understanding how these drugs might affect both the pregnant individual and the developing fetus is an important consideration. Medical guidance is essential for its use during pregnancy.
General Considerations for Cortisone in Pregnancy
When considering any medication during pregnancy, healthcare providers assess the potential benefits against any potential risks to the pregnant individual and the fetus. Most drugs administered during pregnancy can transfer to some extent into the fetal circulation through the placenta. The placenta acts as a partial barrier, but most drugs can transfer to the fetus. The extent of transfer depends on factors like the drug’s properties.
Drug classification systems, such as the Pregnancy and Lactation Labeling Rule (PLLR), provide information on known risks to guide decisions. Cortisone reduces inflammation and suppresses the immune system. Its use in pregnancy is carefully considered based on the specific type, dose, and duration of treatment.
Specific Forms of Cortisone and Their Safety
Cortisone’s safety varies by administration method, as different forms have varying systemic absorption, affecting fetal exposure.
Topical corticosteroids, applied directly to the skin, generally have low systemic absorption, meaning very little of the medication enters the bloodstream. This typically translates to a lower risk during pregnancy. However, using high-potency topical formulations over large body areas or for extended periods could lead to increased absorption and should be approached with caution. Low-to-mid strength topical corticosteroids are often a first-line treatment for skin conditions like psoriasis or eczema during pregnancy.
Inhaled corticosteroids, commonly used for respiratory conditions like asthma, deliver medication directly to the lungs, resulting in low systemic absorption. Continuing inhaled corticosteroids at low to moderate doses is often recommended to maintain asthma control, as uncontrolled asthma poses greater risks to both the pregnant individual and the fetus. Budesonide is one of the most studied inhaled corticosteroids in pregnancy and is often preferred.
Oral corticosteroids, such as prednisone, are absorbed more extensively into the bloodstream, leading to higher systemic exposure. While they are sometimes necessary for severe conditions, their use during pregnancy requires careful consideration due to potential risks. Older studies suggested a small increased chance of oral clefts if used in the first trimester, though newer research does not consistently support this finding, or indicates the risk is very small.
Prolonged use of oral corticosteroids has been associated with a potential for preterm delivery and lower birth weight. Other potential risks include gestational diabetes and pre-eclampsia. However, it is often challenging to determine if these outcomes are due to the medication or the underlying severity of the condition being treated. Prednisone and prednisolone are generally considered compatible with pregnancy when medically necessary, with the lowest effective dose used for the shortest possible duration.
Injected corticosteroids, used for localized issues like joint pain, have variable systemic absorption. For instance, specific injected corticosteroids like betamethasone or dexamethasone are intentionally used for fetal lung maturation in cases of anticipated preterm birth. This specific use is recommended between 24 and 34 weeks of gestation for individuals at risk of preterm labor within seven days, as it can significantly reduce the risk of respiratory distress syndrome in newborns.
Conditions Requiring Cortisone Treatment
Cortisone treatment during pregnancy is often necessary for conditions that could pose greater risks to the pregnant individual or fetus if left untreated. For instance, severe asthma exacerbations can lead to oxygen deprivation for both the pregnant individual and the baby, making oral corticosteroids a necessary intervention in some cases. Uncontrolled asthma has been linked to preterm birth, low birth weight, and other perinatal complications.
Autoimmune diseases, such as lupus or rheumatoid arthritis, frequently require corticosteroid therapy to manage disease activity and prevent flare-ups that could negatively impact the pregnancy. For example, low-dose glucocorticoid treatment (often 10 mg daily of prednisone or less) may be continued throughout pregnancy for rheumatic conditions.
Severe skin conditions like eczema or psoriasis might also necessitate cortisone to alleviate discomfort and prevent complications. Topical corticosteroids are typically the first approach for these conditions, with systemic options considered for severe, widespread cases. In situations where preterm birth is a concern, antenatal corticosteroids are administered to help accelerate the development of the fetal lungs, significantly improving outcomes for premature babies.
Making Informed Decisions About Cortisone
Deciding on cortisone use during pregnancy involves a thorough discussion with a healthcare provider. It is important to consult with a doctor before starting, stopping, or changing any medication during pregnancy. An open conversation allows for a comprehensive assessment of the specific medical condition, the severity of symptoms, and the potential impact on both the pregnant individual and the developing fetus.
Healthcare providers weigh the potential benefits of treating the condition with cortisone against any possible risks, considering factors like the dosage, duration of treatment, and the individual’s overall health. For many conditions, the risks associated with uncontrolled disease often outweigh the potential risks of corticosteroid use. Asking questions about the specific type of cortisone, the reason for its use, and alternative options can help ensure a clear understanding of the treatment plan. Sometimes, cortisone may be the most effective or only available treatment for a serious condition, making its careful use a necessary part of managing a healthy pregnancy.