Dehydroepiandrosterone (DHEA) is a naturally occurring steroid hormone precursor produced by the adrenal glands, often taken as a supplement. The safety of DHEA use during gestation is a concern for individuals using it for fertility or anti-aging purposes. Since DHEA acts as a precursor to sex hormones, its presence in the maternal circulation raises questions about its potential influence on a developing fetus. Medical advice is generally one of extreme caution due to the limited human data available on its effects during pregnancy.
Understanding DHEA and Its Role in Fertility
DHEA is a compound the body converts into potent sex steroids, such as androgens (testosterone) and estrogens (estradiol). The hormone’s natural levels peak in early adulthood and decline with age. This age-related decline is why DHEA supplementation has been explored in reproductive medicine.
Individuals often take DHEA to address diminished ovarian reserve (DOR), a condition characterized by lower egg quantity and quality. Studies suggest that DHEA supplementation may improve ovarian function by increasing the number of eggs that reach maturity and potentially reducing the rate of pregnancy loss. By boosting androgen levels within the ovary, DHEA creates a more favorable hormonal environment for the early stages of follicular development.
Medical Safety Classifications for DHEA During Pregnancy
The medical and regulatory stance on DHEA use during pregnancy is defined by a lack of comprehensive safety data. DHEA is generally classified as a substance for which there is insufficient evidence to determine risk, leading to high caution from healthcare providers. This is the standard approach when large-scale, controlled human studies in pregnant populations are absent.
The primary concern stems from DHEA’s metabolic pathway, which generates androgens, or male hormones. While the body naturally produces DHEA during gestation, the level of exogenous supplementation is not well-regulated or understood in this context. Many authorities advise against the use of DHEA throughout pregnancy because of this uncertainty and the theoretical risks associated with hormonal exposure.
One specific prescription form of DHEA is assigned to a category that advises against use during pregnancy unless the benefits outweigh the potential risk. This classification reflects the potential for adverse pharmacological effects, even though the exact risk to the human fetus is unknown. The standard of care prioritizes fetal safety, making the unknown risk of a supplement a sufficient reason for its avoidance.
Potential Effects on Fetal Development
The specific biological concern with DHEA supplementation in pregnancy is its potential to increase the exposure of the developing fetus to androgens. Since DHEA is a precursor that converts into testosterone, taking the supplement raises the overall concentration of these hormones in the maternal-fetal circulation. High levels of androgens are known to be harmful to the fetus, particularly during the first trimester when organ systems and sexual characteristics are forming.
The theoretical risk is most pronounced for a female fetus, where elevated androgen exposure can lead to virilization, or the development of male-like characteristics. This can result in the masculinization of the external genitalia, potentially causing conditions like ambiguous genitalia. Although human data on this specific outcome from DHEA supplementation is scarce, the drug’s known mechanism of action as an androgen precursor raises a significant biological flag.
The body naturally increases its own DHEA production during pregnancy, with the fetal adrenal gland eventually becoming a major source of this hormone. Introducing supplementary DHEA, especially in the early weeks, adds to this hormonal load during a critical period of sexual differentiation. While some limited case reports suggest that low-dose DHEA may be maintained in specific, complex cases of recurrent miscarriage to support estradiol levels, this is an exception and not the general recommendation.
Guidelines for Discontinuing DHEA Upon Conception
For individuals who were taking DHEA for fertility and receive a positive pregnancy test, the immediate guideline is to cease supplementation and consult a healthcare provider without delay. This medical consultation should involve either an obstetrician-gynecologist or a reproductive endocrinologist. The urgency of stopping DHEA is based on the need to minimize any potential hormonal influence during the earliest, most sensitive weeks of fetal development.
Physicians will generally recommend that patients stop DHEA once pregnancy is confirmed by a positive home urine test or, in a fertility clinic setting, after the second positive blood test confirming a progressing pregnancy. When speaking with the doctor, it is important to provide the exact dosage of the DHEA supplement being taken and the date of the last dose. This information is necessary for the physician to accurately assess the level of fetal exposure and determine any necessary monitoring or follow-up.