Fetal Adrenal Suppression Due to Maternal Corticosteroid Use: Case ReportIn pregnancy, pharmacokinetics of corticosteroids changes. Systemic corticosteroids are not teratogenic. Pregnant women receiving corticosteroid therapy suffer the same side effects and high dose prednisolone in pregnancy as do treated women who are not pregnant. Clinical experience suggests no abnormalities of children of mothers treated with usual doses of prednisone and methylprednisolone throughout pregnancy, but premature rupture of amniotic membranes and low birthweight babies testosterone sale occur. Betamethasone and dexamethasone are used to treat the fetus. The effect on the fetus of bolus doses of methylprednisolone is unknown.
Prednisone Use During Pregnancy | korean-war.info
During pregnancy, steroids are usually used in maternal diseases such as adrenal failure or other autoimmune diseases, e. Endogenous or exogenous maternal steroids are metabolized by the placental enzyme 11 beta-hydroxy steroid dehydrogenase type 2. Prednisolone and methylprednisolone are highly sensitive to this enzyme, while dexamethasone and betamethasone are less well metabolized. Steroids which can cross the placental barrier are administered in cases like fetal lupus, congenital adrenal hyperplasia and for enhancement of fetal lung maturation, whereas steroids used in maternal diseases are usually the ones with low affinity to the placenta; however, in case of long-term use or in high doses, placental enzyme saturation occurs and thus, resulting in fetal adrenal suppression.
Antenatal steroids can lead to low birth weight, as observed in our patient. Here, we report a case with fetal adrenal suppression due to maternal methylprednisolone use presenting with early hypoglycaemia and late hyponatremia in neonatal period and requiring three-month replacement therapy.
Short-term corticosteroid treatment is given in case of preterm labor to enhance fetal lung maturation 8. When using corticosteroids during pregnancy, the choice of preparation type and dose is of utmost importance - steroids crossing the placenta freely should be given if the target is fetus, while those passing across the placenta should be used in smaller amount if maternal disorders are being treated 1. In this article, adrenal suppression pattern in a newborn exposed to long-term maternal methylprednisolone therapy were presented with special emphasis on short term follow up of such infants.
A minute-old newborn, whose mother used 64 mg methylprednisolone per day during her pregnancy due to ITP, was hospitalized for follow-up. Pregnancy duration was 39 weeks. The neonate was grams th percentile at birth with head circumference of 36 cm th percentile and height of 50 cm th percentile.
Whole blood examination showed hemoglobin level of Biochemistry profile revealed the following: On adrenal ultrasonographic examination, the adrenal glands were small measuring 10x2 mm in size for the right and 12x2 mm for the left one.
Since the patient was thrombocytopenic, 0. On the fourth day, cortisol level was On the 10th day, rechecking the adrenal functions, cortisol level was found to be 0. The result of low-dose ACTH test on the 40th day postpartum was as follows: Therefore, methylprednisolone therapy was continued and stopped by slowly tapering at the end of the 3rd month Table 1. Low-dose ACTH test was repeated in the 4th posnatal month and the results were as follows: After 30 minutes, cortisol level was Hormone tests and their results are summarized in Table 1.
These results showed that the patient was relived from adrenal suppression. Corticosteroids are given during pregnancy if needed in maternal diseases or other pregnancy-related problems as well as to treat certain fetal diseases; in the latter cases, corticosteroids capable of crossing the placenta are administered to the mother 5 , 6 , 7 , 8 , 9. As side effects to the mother, steroids used during pregnancy can cause weight gain, dyslipidemia, hypertension, cushingoid appearance, acne, hypertrichosis, psychological problems 8.
Corticosteroids are metabolized in the placenta by the help of the enzyme b-hydroxylase steroid dehydrogenase-2 Cortisol, a physiologic steroid, is metabolized to cortisone.
Similarly, synthetic glucocorticosteroids are metabolized to inactive metabolites in the placenta. Besides this, when taken in high doses and for long period of time, prednisolone and methylprednisolone themselves can saturate the placental enzymes and, as a result, large amount of corticosteroids can cross the placental barrier causing significant suppression of the fetal glands, as observed in our case 5. Fetal adrenal suppression develops approximately within 14 days after maternal steroid use, therefore, the neonate may be born with ACTH suppression 5.
Adrenal gland insufficiency becomes prominent on postnatal day 3 - the neonate develops hyponatremia, hypoglycemia and hypotension.
Since there is central adrenal insufficiency due to long-term steroid effect, potassium level is within normal limits, or even low. It is well known that long-term steroid use can cause low birth weight, as in our case In our patient, high-dose methylprednisolone saturated the placental enzymes, the steroids crossed the placenta more significantly and in higher amounts, thus, causing fetal adrenal suppression.
On the fourth day, cortisol level was within normal ranges, but we consider that there might be an interference between crossed maternal steroids, their metabolites and fetal cortisol. Since on the 10th day ACTH and cortisol levels were found to be suppressed, this shows the importance of measuring cortisol and ACTH levels during the second week. Thus, steroids crossing the placenta in small amount should be preferred during pregnancy in case of maternal disorders necessitating steroid use.
The newborns should be followed postnatally. On postnatal day 4, basal cortisol and ACTH levels should be measured, and if needed, adrenal reserves should be checked by conducting low-dose ACTH test. For patients with adrenal insufficiency, physiological replacement should be started.
Moreover, in case of stressful conditions, the dose of steroid should be increased times, because it has been shown that antenatal steroids can change the response to neonatal stress Low-dose ACTH test should be repeated at specified intervals and, as soon as adrenal response returns to normal, replacement therapy should be slowly tapered and stopped.
National Center for Biotechnology Information , U. J Clin Res Pediatr Endocrinol. Published online Sep 9. Received May 3; Accepted Jun This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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