High-Dose Methylprednisolone in a Pregnant Woman with Crohn’s Disease and Adrenal Suppression in Her Newborn

Abstract

Background: The synthetic corticosteroid methylprednisolone is used for the treatment of acute exacerbations of Crohn’s disease, also in pregnancy. Its use is considered to be less harmful than the effect of active disease on the fetus. Adrenal suppression in a fetus due to administration of methylprednisolone has hitherto been rarely published. Objective: To present a case of neonatal adrenal suppression due to the use of high-dose methylprednisolone in late pregnancy of a woman with Crohn’s disease. Methods and Results: Clinical signs of adrenal suppression were observed in the newborn 3 h after birth. After hydrocortisone supplementation and intensive therapy the baby recovered completely. Conclusions: Life-threatening adrenal suppression, requiring hydrocortisone supplementation and intensive therapy, was observed and successfully treated in a newborn, whose mother had received high-dose methylprednisolone in late pregnancy.

Inflammatory bowel disease and pregnancy: an update

“…Premature rupture of membranes and adrenal insufficiency of the newborn were noted in a study of post-transplant recipients exposed to corticosteroids during pregnancy [87]. Notably, a neonate born to a mother with CD who ingested 32 mg oral prednisone and used 100 mg hydrocortisone enemas daily in the last month prior to delivery was found to develop adrenal insufficiency within 3 h after birth [88]. An additional concern involves the development of gestational diabetes.…”

Hypoglycaemic seizure and neonatal acute adrenal insufficiency after maternal exposure to prednisone during pregnancy: a case report

“…The foetus is usually protected from maternal adrenocorticosteroids by placental enzymes (notably 11β-hydrosteroid dehydrogenase type 2) which convert cortisol and synthetic CS to less active metabolites including cortisone. However, it remains unclear if the human placenta can become saturated by high doses of CS or even if CS may accumulate locally until placental saturation [5]. Little information is available concerning the transplacentar passage of CS given by the inhaled or nasal route; even their systemic distribution is highly variable.…”

Proper Use of Inflammatory Bowel Disease Drugs during Pregnancy

“…Therefore, a pediatrician should carefully examine neonates exposed to corticosteroids in utero after birth. Furthermore, corticosteroids are known to increase the risk of gestational diabetes and hypertension, and pregnant women should be followed up stringently by a gynecologist [60] . Prednisolone is the preferred corticosteroid during pregnancy, because of the limited transplacental passage [61,62] .…”