Prednizone and pregnancy related question

i was on pred the whole time. started at 40mg, weaned to 12.5 and stayed on 12.5. I had alot of pregnancy complications including diabetes. My baby was born a few weeks early, but healthy. Baby was monitered every week by ultra sound and/or stress testing. Baby was struggling in utero at the end, so I ended up having an emergency c-section. All seems okay since then tho. I'd rather be on prednisone while pregnant than some of the other meds. Try and stick to a lower dose and WATCH your sugar levels.

Best wishes.

Did either of you experience your cylces being messed up after being on Prednizone?

This is actually my area of research, so I can tell you what we know so far. There's some evidence that prednisone during pregnancy (usually at low doses-10 mgs throught) can lead to growth restiction and lower birth weight in some, but not all, women. Generally, you see a reduction is birth weight compared to those who babies who were not exposed to pregnisone, but the means are usually still within the normal range. It's slightly complicated by the fact that prednisone is always prescribed due to an underlying disease or medical problem, so it's difficult to parse apart whether the effects on the fetus are due to the disease or to the medication. Nevertheless, similar effects occur in animals exposed to comparable doses in utero and prednisone is the synthetic version of a hormone called cortisol, which is integrally involved in the initiating of labor and delivery, as well as fetal growth. Cortisol steadily rises throughout pregnancy, therefore many patients with autoimmune disorders typically see a remission of their symptoms during pregnancy, which seems partially related to the increase in cortisol and partially to the increase in estrogen (both anti-inflammatory hormones). You may consider trying to stop taking prednisone during pregnancy to see if the natural rise in cortisol will attenuate your symptoms, like it seems to in a variety of disorders, including CD, RA, and MS. But, again all of the research is based on taking the averages between groups and seeing if there is a difference between groups, which means that the effects that may be apparent in research do not occur for every woman. Feel free to e-mail me if you have other questions.

Low birth weight, preterm delivery, and fetal growth restriction can be caused by many different things, so it would be problematic to discuss generally the long-term follow-up studies on low birth weight. Fetal exposure to elevated levels of cortisol and prednisone has been associated with long-term consequences for some, but not others, and the consequences likely depend on whether the fetus also has certain genes that make the brain vulnerable to the effects of prednisone (although this hasn't really been tested directly yet, so you couldn't go and get genetic testing). In some ways, this area of research is in its infancy and does not have sufficient follow-up, but the main findings suggest that if the child has problems, then it is most likely in the areas of memory, attention, and reactivity (highly reactive). But, the brain is very plastic, so even if a baby has been exposed to something that increases their chances of having a mild memory problems, you can essentially "work out" your brain and improve the areas that have been preturbed. Regarding breast feeding, that's a difficult question, because there are clearly many, many benefits of breast feeding. When a baby is born, he/she has practically no T cells and receives many of their immune cells via breast milk. In addiiton, breast feeding seems to be important for maternal-infant attachment. The majority of the studies I've seen tend to suggest that breast feeding is safe on low doses of prednisone. One study found some evidence that infant exposure to high levels of cortisol in breast milk increases their likelihood of have an anxious temperament and that women with comparable levels of cortisol in breast milk who did not breast feed did not have infants with an anxious temperament. I personally think that this research is difficult to interpret, because anxious mothers have high levels of cortisol, so it may be a learned response. Moreover, there may be something qualitatively different about women who decide to formula feed (I don't know that this is true, but it's something that wasn't tested in the study). Also, temperament was measured by a questionaire given to the mothers, so we were really getting a pretty biased view of the infant's temperament, in my opinion. Overall, I think the research to date is not great, but it seems like breast feeding is safe on prednisone (ask your doctor, as well) and there are many benefits that out weigh any potential problems.

Forgot to ask one more thing. I've heard that these problems are related to taking this medication during the first trimester (especially weeks 5-12). Are these issues avoided if not taken during this time? Thanks.

Oh...I'm not sure about prednisone versus an active flare. Personally, I would try other options first, like Asacol or Pentasa. I also think that although the research shows effects of prednisone on the fetus, these effects are typically small (e.g. 400 g decrease in birth weight) and don't affect everyone. If you're having an active flare, then that will afffect many other systems that could put your baby at risk. Anemia is really very bad for fetuses and so is malnutrition, so I guess I would choose prednisone over an active flare, but I feel uncomfortable making a recommendation because I'm not an OB/GYN. Can you get an OB/GYN that specializes in Crohn's? Maybe even just for a consultation? I know, at Mt. Sinai in NYC, there are OB/GYNs that specialize in Crohn's, but I don't know about other places.

EmmyT - You are in good hands with the Cleveland Clinic. I am fortunate to live here, and both my GI and OB are there. They absolutely know what they are doing. I trust them implicitly. You should feel very comfortable working with them.