Steroid injections, primarily corticosteroids, are sometimes used during pregnancy to improve outcomes for both the pregnant person and the developing fetus. This article explains when and why these injections are administered, along with their known effects.
Circumstances for Use in Pregnancy
Antenatal corticosteroids are most commonly administered during pregnancy to accelerate fetal lung maturity. They are given when there is a significant risk of preterm birth, typically between 24 and 34 weeks of gestation. The primary goal is to reduce respiratory distress syndrome in preterm infants, a condition where the baby’s lungs are not fully developed.
These injections also help to mitigate other serious complications associated with prematurity, such as intraventricular hemorrhage (bleeding in the brain) and necrotizing enterocolitis (a severe intestinal condition). Corticosteroids work by stimulating the production of surfactant in the fetal lungs, a substance that helps the air sacs stay open. The typical course involves two to four injections given intramuscularly over a 24 to 48-hour period.
While less common, systemic corticosteroids may also be necessary for the pregnant person’s health in specific medical situations. This can include severe exacerbations of conditions like asthma, or flares of certain autoimmune diseases. In these cases, the medication is administered to manage the pregnant person’s symptoms and prevent disease progression, where the benefit to maternal health outweighs potential risks.
Effects on the Pregnant Person
Steroid injections can lead to temporary effects on the pregnant person, which are generally mild and monitored by healthcare providers. A common effect is a temporary increase in blood sugar levels, particularly relevant for individuals with pre-existing diabetes or gestational diabetes. Monitoring blood glucose is important, and some may require adjustments to their diabetes management or additional insulin.
Other temporary side effects may include a rise in blood pressure, fluid retention, and mood changes. Patients might also experience an increased appetite following the injections. A slight, temporary increase in the risk of infection can occur, as corticosteroids have immunosuppressive properties. These effects are usually self-limiting and resolve shortly after treatment.
Effects on the Fetus and Newborn
Antenatal corticosteroids offer substantial benefits for preterm infants, significantly improving their short-term health outcomes. These benefits include a notable reduction in the incidence and severity of respiratory distress syndrome, leading to less need for breathing support after birth. The injections also lower the rates of intraventricular hemorrhage (bleeding in the brain) and necrotizing enterocolitis (a severe intestinal inflammation). Studies indicate a reduced chance of neonatal death for babies born prematurely who received these steroids.
Despite these benefits, there can be some transient effects on the fetus immediately following administration. These may include a temporary decrease in fetal breathing movements and a temporary reduction in heart rate variability. While some research has suggested a potential for a slight, usually temporary, reduction in fetal growth or birth weight, this is often minor and tends to resolve over time.
A rare, usually mild, and self-resolving concern is transient adrenal suppression in the newborn, where the baby’s adrenal glands temporarily produce less of their own steroids. While ongoing research explores very subtle, long-term neurodevelopmental outcomes, current evidence generally indicates that the significant benefits of a single course of antenatal corticosteroids for preterm infants outweigh these potential, often unconfirmed, risks. However, some research suggests a potential link between steroid exposure and mental well-being later in life for babies born at full term after receiving steroids between 22 and 35 weeks. For babies born after 35 weeks, there is a chance of low blood sugar levels after birth, which requires monitoring.
Navigating Treatment Decisions
Decisions regarding steroid injections during pregnancy involve a risk-benefit analysis by the healthcare team. This assessment considers the clinical situation, the gestational age of the fetus, the pregnant person’s overall health, and the fetal well-being. Healthcare providers weigh the potential for preterm birth against the known benefits and potential side effects of the medication.
Current medical guidelines generally recommend a single course of antenatal corticosteroids. This approach is favored due to concerns about potential cumulative effects if repeat courses are given, particularly given some research suggesting a link between multiple courses and an increased risk of cerebral palsy. However, evolving medical guidelines may sometimes indicate exceptions based on specific circumstances.
Open communication and shared decision-making between the pregnant person and their medical provider are important. Individuals should discuss their concerns, understand the rationale for the treatment, and be informed about the potential outcomes. These injections are not given routinely but are reserved for specific, medically indicated circumstances where the benefits to the baby’s health outweigh the potential risks, especially in cases of anticipated preterm birth.