Glucocorticoid Therapy for Rheumatic Diseases: Maternal, Fetal, and Breast-Feeding Considerations



    Corresponding author
    1. Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Department of Pharmacology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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Address reprint request to William F Rayburn, M.D., Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, P.O. Box 26901; 4SP 710, Oklahoma City, OK 73190.


ABSTRACT: Glucocorticoids form the mainstay of therapy for many rheumatic diseases, especially systemic lupus erythematosus (SLE). Prednisone is the drug of choice, because it has been well described during pregnancy and is the primary drug for maintenance therapy or to induce a remission. Principles for prescribing glucocorticoids would apply during pregnancy, recognizing that many effects of rheumatic disease and long-term therapy are similar to physiologic changes of pregnancy. Particular attention should be placed on screening for pregnancy-induced glucose intolerance, hypertension, and delayed fetal growth. Although animal studies suggest an increased risk of oral clefts associated with glucocorticoids, several human studies have failed to demonstrate teratogenic or toxic effects. Nevertheless, rare cases of transient fetal adrenal suppression have been reported, so all infants should be monitored in the nursery. Breastfeeding is safe, with clinically insignificant amounts of the drug being concentrated in breast milk.