Corticosteroid Therapy for the Pregnant Asthmatic Patient

Schätz, Michael; Patterson, Roy; Zeitz, Stanley J.; O'Rourke, John; Melam, Howard

doi:10.1097/00006254-197602000-00010

Cited by 11 publications

(18 citation statements)

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“…The data in humans are more equivocal. One large case series of over 800 asthmatic patients who were maintained on prednisone (average dose 8 mg) during pregnancy showed no increased rate of congenital anomalies [ 18 ]. In contrast, a meta-analysis of studies of prednisone exposure (of any dosage) during pregnancy demonstrated a 3.4 fold increased rate of cleft palate formation in offspring exposed to prednisone in utero [ 19 ].…”

Section: Glucocorticoidsmentioning

confidence: 99%

The Medical Management of the Rheumatology Patient During Pregnancy

Bermas

2014

Contraception and Pregnancy in Patients With Rheumatic Disease

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Congenital anomalies occur in 3 % of normal pregnancies [ 1 ]. Therefore, risk assessment of any particular agent during pregnancy needs to take into account this background rate of teratogenicity. For many years, clinicians relied on the FDA risk categories (A, B, C, D, and X) to assess drugs for safety for use in pregnancy. As Briggs, author of the major textbook in this fi eld, points out, these risk assessments are limited because they are "confusing and simplistic" and incorrectly gave the impression that risk increases from category to category [ 2 ]. The FDA is currently considering new labeling for pregnancy risk. The approach this chapter will take is to present the available data on medication safety in pregnancy and lactation and to synthesize the information regarding drug safety.Each pregnant woman has her own view about assuming risk during her pregnancy. For example, some women will avoid any substance that could have potential risk during pregnancy (caffeine, over-the-counter medications, food-additives) while other women will be willing to assume some risk and modify their ingestion of these substances. Similarly, treating physicians have varying tolerance to risk. While one clinician may be willing to prescribe TNF-α blockers during pregnancy, others will be uncomfortable recommending these medications. Therefore, when approaching management decisions of rheumatic diseases during pregnancy, it is helpful for the treating clinician to be aware of both the patient's and their own risk tolerance, in addition to the available medical data. To this end, up-front discussions prior to conception or early in pregnancy regarding what medications may be used safely and comfortably in the case of a disease fl are are ideal.

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Section: Glucocorticoidsmentioning

confidence: 99%

The Medical Management of the Rheumatology Patient During Pregnancy

Bermas

2014

Contraception and Pregnancy in Patients With Rheumatic Disease

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“…Abortion has not been reported after the middle trimester of pregnancy in patients with VKH syndrome. In the general population, the incidence of spontaneous abortion is 10% (Schatz et al 1975). The incidence of abortion in patients with VKH syndrome with or without systemic corticosteroid treatment may not be as high as that in the general population.…”

Section: Discussionmentioning

confidence: 97%

“…Because Reinsch et al (1978) reported that systemic corticosteroid administration during pregnancy induced low birth weight, the low birth weights of the babies in the present case and in a second case (Steahly 1990) that were delivered by patients with VKH also might be the result of systemic corticosteroid administration. Although a small dose of systemic corticosteroids does not induce congenital adrenal dysfunction (Schatz et al 1975), high-dose corticosteroid administration to pregnant women may induce adrenal dysfunction in the delivered babies (Kraus 1975). To reduce these side effects, we prescribed prednisolone.…”

Section: Discussionmentioning

confidence: 99%

“…In the general population, the incidence of congenital malformations was reported to be 2-3% (Schatz et al 1975). Systemic corticosteroids administered to mice and rabbits produce teratogenic effects such as cleft palate and cardiac defects (Moore & Persaud 1993b).…”

Section: Discussionmentioning

confidence: 99%

“…Moorthy et al (1995) reported that systemic corticosteroid administration significantly improved the course and prognosis of VKH syndrome when used properly, although Yamamoto et al (1986) reported good visual outcome without systemic corticosteroid use. Schatz et al (1975) reported that small doses (prednisone equivalent under 8.7 mg) of systemic corticosteroids administered during pregnancy do not increase the risk of abortion or congenital malformation. However, do VKH syndrome and high-dose systemic corticosteroid administration in pregnant woman induce abortion or abnormalities in delivered babies?…”

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confidence: 99%

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Vogt‐Koyanagi‐Harada syndrome in a pregnant patient treated with high‐dose systemic corticosteroids

Doi

Matsubara

Uji

2000

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: Vogt-Koyanagi-Harada (VKH) syndrome is usually treated with highdose systemic corticosteroids. However, in a pregnant patient with VKH syndrome, the effects of high-dose corticosteroids on the fetus are controversial. We discuss treating VKH syndrome during pregnancy, systemic corticosteroids, and abnormalities in the delivered infant. Methods: Case report and literature review. Results: A 26-year-old Japanese woman in the 16 th week of gestation was diagnosed with VKH syndrome and treated with high-dose systemic prednisolone after the 18 th week of gestation. Although the patient's ocular findings gradually improved, a low-birth-weight infant was delivered with epibulbar dermoid, lipodermoids, and preauricular appendages. Although low birth weight might result from systemic prednisolone administration, the anomalies of the infant may have been inherited rather than caused by VKH syndrome and high-dose systemic corticosteroid administration. Conclusion: In this case and previously reported cases, VKH syndrome and systemic corticosteroids administered during pregnancy may not precipitate abortion and congenital malformation.

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Safety of drug therapy for inflammatory bowel disease in pregnant and nursing women

Connell

1996

Inflamm Bowel Dis

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: Drug therapy is justified in pregnant patients with active inflammatory bowel disease. Selection of medical treatment depends on disease severity and the potential for fetal toxicity. Preferably, pregnancy should be planned to coincide with periods of disease quiescence, so that drug requirements can be minimized. Sulphasalazine and prednisolone are clearly safe in pregnancy and lactation. Preliminary studies suggest that lowto-moderate-dose mesalazine is well tolerated in pregnant and nursing mothers. Immunosuppressive therapy during pregnancy in transplant and nontransplant recipients may be associated with an increased risk of fetal growth retardation and prematurity. The risk of congenital malformations from azathioprine and cyclosporin is not markedly increased, although exposure to methotrexate during the first trimester may cause fetal loss and characteristic anomalies. Short-term therapy with metronidazole in the first trimester is not associated with an increased risk of teratogenicity, although the safety of this drug in pregnancy as primary therapy for Crohn's disease using higher doses for prolonged periods has not been confirmed.

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Corticosteroid Therapy for the Pregnant Asthmatic Patient

Cited by 11 publications

References 0 publications

The Medical Management of the Rheumatology Patient During Pregnancy

The Medical Management of the Rheumatology Patient During Pregnancy

Vogt‐Koyanagi‐Harada syndrome in a pregnant patient treated with high‐dose systemic corticosteroids

Safety of drug therapy for inflammatory bowel disease in pregnant and nursing women

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