Corticosteroids, Pregnancy, and HELLP Syndrome: A Review

Abstract

Corticosteroids are potent antiinflammatory and immunosuppressive drugs, which are used in the treatment of a wide range of medical disorders. During pregnancy, several corticosteroids are administered for maternal as well as fetal reasons. Prednisone and prednisolone show limited transplacental passage and are thus used for treatment of maternal disease. Dexamethasone and betamethasone, drugs that can easily cross the placenta, are more suitable for fetal indications. During the last decade, administration of corticosteroids was introduced in the treatment of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome), a severe form of preeclampsia unique to human pregnancy. Several randomized, controlled trials as well as other prospective and retrospective studies have been performed to investigate this beneficial effect of corticosteroids on biochemical measures and clinical signs. This review discusses the characteristics of corticosteroids in humans and details the use of corticosteroids during pregnancy. A review of literature on the effect of corticosteroids on HELLP syndrome is given and possible mechanisms of action are discussed.

Increased Serum Concentrations of Circulating Glycocalyx Components in HELLP Syndrome Compared to Healthy Pregnancy: An Observational Study

“…To detect hemolysis, haptoglobin serum levels were measured instead of LDH because haptoglobin seems to be the more specific indicator. 22,26,27 3. Healthy female nonpregnant volunteers aged 27 to 38 years (laboratory control group [CG]), n ¼ 10.…”

Liver disease in pregnancy

“…16,17,20,21 In the absence of randomized trials, a National Institutes of Health Consensus Development Panel suggests that perinatal outcome at less than 34 weeks' gestation is better when corticosteroids (betamethasone or dexamethasone, which cross the placenta) are used for 24 to 48 hours, with delivery thereafter; the main benefit of this therapy is fetal lung maturity but it also improves the maternal platelet count in some cases. There are some advocates for giving dexamethasone to all cases, starting before delivery but completed postpartum with no delay in delivery; they may also aid maternal stability during the transfer time to a tertiary referral center.…”

HELLP Syndrome-A life threatening complication of severe pre eclampsia

“…Liberated haemoglobin is converted to unconjugated bilirubin in the spleen or may be bound in the plasma by haptoglobin. The haemoglobin-haptoglobin complex is cleared quickly by the liver, leading to low or undetectable haptoglobin levels in the blood, even with moderate haemolysis 16 . Low haptoglobin concentration (< 1 g/L -< 0.4 g/L) can be used to diagnose haemolysis and is the preferred marker of haemolysis 17 .…”