Glucocorticosteroids pregnancy

Inprinciple, the following points should be observed in systemic therapy with glucocorticoids during pregnancy (Schaefer C et al. 2012):

• In general, non-halogenated systemic glucocorticoids should be used. These are largely inactivated in the placenta.
• Prednisolone is the systemic glucocorticoid of choice (gradient mother: child = 10:1).
• Prednisolone is generally considered safe during pregnancy (Ambros-Rudolph CM et al. 2017).
• the usual dosage regimens can be maintained.
• For the treatment of pregnancy dermatoses glucocorticoids are usually used as short-term therapy (< four weeks). No side effects are to be expected.
• If a >10-day continuous glucocorticoid therapy is required in the 1st trimester, especially between weeks 8-11, the daily dose of 10-15 mg should not be exceeded! At higher doses a potential risk of cleft lip and palate cannot be excluded.
• If high-dose treatment is required for many weeks until birth, fetal growth should be monitored sonographically and possible adrenal insufficiency of the newborn should be considered.

Topical therapy with glucocorticoid externa in pregnancy:

• In the external application of glucocorticoids, preference should be given to newer, substituted, non-fluorinated preparations (e.g. prednicarbate, methylprednisolone aceponate, mometasone furoate) (note also inhaled glucocorticoids).
• Highly effective topical glucocorticoids should not be used. They increase the risk of striae cutis distensae. The use of topical glucocorticoids has not been shown to increase the risk of malformation (especially cleft lip and palate), consultation, effects or premature birth.
• The use of strong and very strong glucocorticoids and exceeding a cumulative total dose of 300 g was associated with reduced birth weight (Chi CC et al. 2013).

1. Ambros-Rudolph CM et al (2017): Specific dermatoses during pregnancy. Dermatologist 68: 87-94
2. Chi CC et al (2013) Pregnancy outcomes after maternal exposure to topical corticosteroids: a UK population-based cohort study. JAMA Dermatol 149:1274-1280.
3. Schaefer C et al (2012) Prescription in pregnancy and lactation, 8th ed. Urban & Fischer, Munich