Dexamethasone is a corticosteroid medication that mimics hormones produced by the adrenal glands. It has strong anti-inflammatory and immunosuppressive properties, used to treat various medical conditions. During pregnancy, its use involves balancing potential benefits against possible risks for both the pregnant individual and the developing baby.
Reasons for Use During Pregnancy
Dexamethasone is often administered during pregnancy to promote the maturation of a baby’s lungs when preterm birth is anticipated. This significantly reduces the risk and severity of respiratory distress syndrome (RDS) in newborns, a common complication of prematurity. Dexamethasone accelerates lung development, making it less likely for preterm babies to experience breathing problems after birth and improving their chances of survival. This benefit is particularly noted for births occurring between 26 and 34 weeks of gestation.
Dexamethasone may also be prescribed for various maternal conditions, such as autoimmune disorders, severe allergic reactions, or severe asthma. In these cases, the benefits of controlling the condition typically outweigh the potential risks to the pregnancy.
Potential Effects on the Pregnant Individual
Dexamethasone can lead to several temporary side effects for the pregnant individual. Common effects include elevated blood sugar levels, which may increase the risk of developing gestational diabetes. Some individuals might also experience increased blood pressure, fluid retention, or changes in mood, such as irritability or anxiety.
Other maternal side effects include sleep disturbances, headaches, and facial flushing. Evidence suggests that dexamethasone treatment does not significantly increase the risk of maternal infections. These effects are typically short-term and often resolve shortly after the treatment is completed.
Potential Effects on the Developing Baby
Dexamethasone offers significant benefits to the developing baby, by reducing the risks associated with preterm birth. Administering it before anticipated preterm delivery decreases the incidence of respiratory distress syndrome, intraventricular hemorrhage (bleeding in the brain), and necrotizing enterocolitis (a severe intestinal condition) in premature infants. This intervention can lead to a lower risk of neonatal death and improved overall survival rates for babies born prematurely.
Despite these benefits, there are potential risks and considerations for the baby. Temporary reductions in fetal breathing movements may occur after exposure. Animal studies have suggested a potential for reduced birth weight and a possible increased incidence of cleft palate with long-term or high-dose exposure, though the relevance of these findings to human pregnancies is often questioned in short-term therapeutic use. There are also ongoing discussions regarding potential long-term neurodevelopmental effects, with some studies indicating a possible association between antenatal dexamethasone exposure and cognitive development, though more large-scale human studies are needed to confirm these findings.
Important Considerations for Use
The administration of dexamethasone during pregnancy requires careful medical judgment and supervision. The timing and dosage are crucial for maximizing benefits while minimizing potential risks. For fetal lung maturity, a common regimen involves four intramuscular doses of 6 mg each, given 12 hours apart, typically for pregnant individuals at risk of preterm delivery between 24 and 34 weeks of gestation. The optimal benefit is often observed if birth occurs between 24 hours and seven days after completing the treatment.
Accurate gestational age dating is important to ensure the medication is given within the most effective and safest window. Dexamethasone should only be used under the guidance of a healthcare provider who can assess the individual circumstances, weigh the potential benefits against the risks, and monitor both the pregnant individual and the baby. Self-medication is not advised due to the complexities involved in its use during pregnancy.