Prednisone is a corticosteroid that decreases inflammation and suppresses the body’s immune responses. When a pregnant individual requires prednisone in the third trimester, healthcare providers carefully consider its use. This decision is made when potential benefits for the mother or baby outweigh associated risks. Prednisone use in pregnancy is individualized.
Medical Reasons for Use in the Third Trimester
Doctors prescribe prednisone in the third trimester for two main reasons: managing maternal health conditions and, less commonly, supporting fetal development. For the pregnant individual, prednisone helps manage flare-ups of autoimmune diseases like lupus or rheumatoid arthritis, which can intensify during pregnancy. It also aids in controlling severe, uncontrolled asthma, preventing serious respiratory complications for both mother and baby. Treatment for these conditions is essential to maintain maternal well-being and ensure a healthier pregnancy outcome.
Maintaining stable health for the pregnant individual is paramount, as uncontrolled chronic illnesses can pose greater risks than the medication itself. Prednisone helps prevent worsening symptoms that could lead to hospitalizations, stabilizing the mother’s condition and contributing to a more favorable environment for the developing baby.
For fetal development, corticosteroids are sometimes administered to accelerate lung maturation in anticipated preterm labor. This is primarily achieved with other corticosteroids like betamethasone or dexamethasone, which are typically injected and cross the placenta more effectively than prednisone. While prednisone is less effective for direct fetal lung maturation, the corticosteroid class stimulates surfactant production, helping the baby’s lungs function properly after birth. This reduces the risk of respiratory distress syndrome in premature newborns.
Maternal Health Considerations
Prednisone use in the third trimester can present several maternal health considerations. One common concern is the potential for developing or worsening gestational diabetes, as corticosteroids affect blood sugar regulation. Pregnant individuals may need closer monitoring of blood glucose levels. Healthcare providers often adjust dietary recommendations or introduce insulin therapy if blood sugar levels become consistently elevated.
Prednisone use can also lead to elevated blood pressure or increase the risk of preeclampsia, a serious pregnancy complication characterized by high blood pressure and potential organ damage. Fluid retention, or edema, is another potential effect, manifesting as swelling in the hands, feet, and face. While some swelling is normal in pregnancy, a sudden or excessive increase in fluid retention warrants medical attention.
The immune-suppressing action of prednisone, while beneficial for autoimmune conditions, can also increase susceptibility to infections. Vigilance against common infections is important. Prompt reporting of any illness signs to a healthcare provider is advised for timely intervention.
Impact on the Fetus and Newborn
Prednisone use during the third trimester can have specific implications for the developing fetus and newborn. One potential impact is lower birth weight, associated with long-term oral corticosteroid use during pregnancy. This effect may also be influenced by the underlying maternal condition, as certain chronic illnesses can contribute to lower birth weight.
A more specific concern for newborns is the risk of temporary neonatal adrenal insufficiency, or hypoadrenalism. This occurs because the baby’s adrenal glands, which produce cortisol, may temporarily reduce their production due to prednisone exposure in the womb. Cortisol helps the body respond to stress, regulate metabolism, and maintain blood pressure.
Medical teams carefully monitor newborns whose mothers received prednisone during pregnancy. This monitoring may involve observing for symptoms such as low blood sugar, feeding difficulties, or lethargy. Close medical oversight ensures prompt intervention if the newborn shows signs of impaired adrenal function, supporting the baby’s transition to independent cortisol production.
Considerations for Delivery and Breastfeeding
For pregnant individuals on long-term prednisone, specific considerations arise during labor and delivery to support their body’s stress response. A “stress dose” of steroids may be administered during childbirth. This temporary increase helps the body cope with the physical demands of labor, a significant physiological stressor. Prolonged external steroid use can suppress the body’s natural cortisol production, necessitating this supplementary dose.
This stress dose is typically given intravenously, as oral medication absorption can be unreliable during labor. The healthcare team determines the appropriate dose and duration, often continuing for about 24 hours postpartum, to ensure the mother’s stability. This helps prevent maternal adrenal insufficiency during and immediately after delivery.
Regarding breastfeeding, prednisone is generally considered compatible, with only small amounts passing into breast milk. Benefits of continuing breastfeeding usually outweigh minimal risks to the infant. For individuals taking higher doses, timing the prednisone dose around feedings can further reduce infant exposure. Taking the medication immediately after nursing and waiting three to four hours before the next feeding can minimize its concentration in breast milk. While very high doses might theoretically affect infant growth or temporarily reduce milk supply, such effects are rare, and infant monitoring is recommended.