Corticosteroid Therapy for the Pregnant Asthmatic Patient

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

doi:10.1001/jama.1975.03260070062025

Cited by 157 publications

(23 citation statements)

References 16 publications

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“…GCs prior to and during pregnancy do not seem to have a negative impact on the development of the fetus. GCs in high doses have caused low birth weights in humans and cleft palate in experimental animal models,58 59 but there is no evidence that in humans prednisone or methylprednisolone are teratogenic (Food and Drug Administration risk category B,60), category III evidence 61. The incidence of infection was not increased in neonates who had been exposed to GCs in utero (category IB) 62…”

Section: Resultsmentioning

confidence: 99%

EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases

Hoes

Jacobs

Boers

et al. 2007

Annals of the Rheumatic Diseases

351

222

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Objective: To develop evidence-based recommendations for the management of systemic glucocorticoid (GC) therapy in rheumatic diseases. Methods: The multidisciplinary guideline development group from 11 European countries, Canada and the USA consisted of 15 rheumatologists, 1 internist, 1 rheumatologist-epidemiologist, 1 health professional, 1 patient and 1 research fellow. The Delphi method was used to agree on 10 key propositions related to the safe use of GCs. A systematic literature search of PUBMED, EMBASE, CINAHL, and Cochrane Library was then used to identify the best available research evidence to support each of the 10 propositions. The strength of recommendation was given according to research evidence, clinical expertise and perceived patient preference. Results: The 10 propositions were generated through three Delphi rounds and included patient education, risk factors, adverse effects, concomitant therapy (ie, non-steroidal anti-inflammatory drugs, gastroprotection and cyclo-oxygenase-2 selective inhibitors, calcium and vitamin D, bisphosphonates) and special safety advice (ie, adrenal insufficiency, pregnancy, growth impairment). Conclusion: Ten key recommendations for the management of systemic GC-therapy were formulated using a combination of systematically retrieved research evidence and expert consensus. There are areas of importance that have little evidence (ie, dosing and tapering strategies, timing, risk factors and monitoring for adverse effects, perioperative GC-replacement) and need further research; therefore also a research agenda was composed.

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Section: Resultsmentioning

confidence: 99%

EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases

Hoes

Jacobs

Boers

et al. 2007

Annals of the Rheumatic Diseases

351

222

View full text Add to dashboard Cite

show abstract

“…The magnitude of any effect on adverse perinatal outcome is small and related to the degree of control of the asthma. One retrospective study reported a higher incidence of congenital abnormalities in the children of asthmatic women10 but this has not been shown to occur in two large prospective studies,3 13 nor in any of the other studies of asthma in pregnancy6 7 16 19 including a recent retrospective case control study of 101 pregnancies 19…”

Section: Effect Of Asthma On Pregnancymentioning

confidence: 99%

“…There have been more recent concerns regarding possible deleterious effects of steroids later in gestation on fetal growth and lung and neuronal development33 and on hypertension 34. In addition, as discussed above, the association between asthma and preterm labour may in part be due to corticosteroid therapy6 7 16 and this association is also described for other medical conditions treated with oral corticosteroids in pregnancy 35…”

Section: Management Of Asthma In Pregnancymentioning

confidence: 99%

Respiratory diseases in pregnancy bullet 1: Asthma in pregnancy

Nelson‐Piercy¹

2001

Thorax

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“…Despite animal evidence showing an increased risk of cleft palate with corticosteroid administration during pregnancy (91), recent clinical studies suggest that there is no increased risk of either cleft palate or other congenital malformations in humans (80,92,93). Warrell and Taylor (94) found a high frequency of stillbirth or placental insufficiency in mothers receiving prednisolone during pregnancy, and they speculated that prednisolone had a deleterious effect on plac(~nta1 function.…”

Section: Asthmamentioning

confidence: 99%