# Taking Steroids Throughout Pregnancy



## MissyMinx (Jan 3, 2010)

Hi there, 

I wonder if you could please advise me.  I am currently 14+3 with twins.  Before getting pregnant, I was diagnosed with an exceptionally rare autoimmune disease called AutoImmune Progesterone Dermatitis, which is associated with Infertility and Miscarriage.

Before and throughout the first 12 weeks of my tx, I took 40mg Prednisolone in order to supress any autoimmune activity.  As directed by my Cons, I weaned off this at 12 weeks, and since 14 weeks, I have been steroid free.  The problem that I am now facing is that my APD is flaring dreadfully.  My NHS Immunologist has never seen anyone with this complaint before, and has openly told me that he is at a total loss as to how to treat me.  My Fetal Medical Cons is also unsure of the best course of action.

It has been mentioned that the only way forward may be to keep me on steroids throughout the pregnancy, although at a reduced dose.  I am very concerned about the implications of this, as I understood that the use of steroids throughout the second trimester may impact the babies development, and may also increase my risk of developing Gestational Diabetes.

I would be happy to tolerate the painful skin eruptions associated with this immune problem, provided that I know that at 14+ weeks, my babies are able to hold their own against any immune activity my body tries to throw at them.

Could you please advise me of the implications of taking steroids throughout pg, and whether there's a 'better' steroid to take that is less likely to cross the placenta and affect the babies.

Thank you so much in advance,  

MM.


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## mazv (Jul 31, 2006)

The UKTIS (UK teratology information service) gives the following advice regarding use of corticosteroids in pregnancy;

_If the use of corticosteroids either systemic, topical or inhaled are indicated in the management of maternal illness at any stage of pregnancy, then treatment should not be withheld._

There is some evidence that use of steroids is linked to intrauterine growth retardation (smaller growth rate/birth weight) however there is no evidence of any long term effects from this and baby can be monitored throughout pregnancy. Long term use of steroids can increase risk of diabetes in patients (regardless of pregnancy) but again this can be monitored for and managed if necessary. There isn't any 'better' corticosteroid to take in pregnancy, all transfer across the placenta.

The big unknown is what effect a flare up of your immune condition will have on both you and baby. i would suggest you are best advise by your consultant and immunologist as they will be best placed to monitor and predict the course of your illness. If they are considering long term therapy then this will be with good reason and judgement considering all aspects of risk v benefit to both you and baby.

As stated above the UK national monitoring service dealing with drug use in pregnancy considers corticosteroids to be prescribable in any stage of pregnancy if needed to manage the maternal illness.

Hope this is helpful?


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