Introduction
Cortisone is a glucocorticoid naturally occurring in the body and produced in the adrenal gland. It is secreted in greater quantities during stress and strain and leads to an increased supply of energy reserves as well as inhibition of the immune system and inflammatory reactions. The various synthetically produced glucocorticoid preparations (colloquially known as cortisone) can be administered in the form of tablets, ointments or sprays and are widely used in medicine. Especially in the therapy of bronchial asthma, rheumatic diseases, many inflammations in the ENT area as well as in the skin area glucocorticoids are frequently used. Thereby, a continuation of the therapy during pregnancy is often indispensable.
Who needs cortisone during pregnancy?
Glucocorticoids are the best studied anti-inflammatory drugs during pregnancy. All in all, the results of the study show that treatment with glucocorticoids during pregnancy, when dosed and used correctly, has a very low risk for the mother and baby. Glucocorticoids can be used for many different conditions during pregnancy.
Especially for the treatment of asthmatic and rheumatic diseases as well as to avoid transplant rejection, a continuation of the therapy is often essential. Glucocorticoids can also be used to inhibit the immune system in the context of autoimmune diseases. In addition, the therapy of skin diseases (e.g. neurodermatitis, eczema, etc.)
must often be continued during pregnancy. Only in rare cases can an alternative medication be used. For the treatment of the various diseases during pregnancy there are often specially developed regimens in which the dosage should be continued. Stopping a cortisone therapy often poses a greater risk to the pregnancy and the baby than continuing the treatment.
What effect does cortisone have on my child?
The effect of the different glucocorticoids on the child depends on the preparation used and the way it is taken. In principle, cortisone produces effects similar to those in adults when it enters the baby’s circulation. When using ointments and sprays, in contrast to therapy with tablets, only small amounts of cortisone enter the mother’s circulation and consequently the baby’s circulation.
The most commonly used glucocorticoid preparations, prednisone and prednisolone, have a very weak effect on the child’s body. This is due to the fact that these preparations are largely inactivated in the area of the placenta. Only about 20% of the amount of cortisone in the mother’s blood reaches the child’s circulation.
Possible effects on the child’s development are therefore only to be feared at very high doses (more than 15 to 20 mg per day) and with long-term use. Other commonly used glucocorticoid preparations are dexamethasone and betamethasone. Compared to the above-mentioned preparations, these are not inactivated in the placenta area and reach the child’s bloodstream in high doses.
For this reason, they are used in rare indications during pregnancy. On the one hand, they are used in cases of imminent premature birth or very early labour. The preparations are injected in high doses in the last third of the pregnancy.
They cause an accelerated development of the child, which significantly increases the probability of survival in premature births. The cortisone-dependent maturation of the lungs at the end of the pregnancy is particularly decisive in this respect. In addition, study results have shown that this therapy leads to a reduced incidence of cerebral haemorrhages and neurological deficits in premature births.
On the other hand, the preparations are injected to prevent congenital cardiac arrhythmia (congenital AV block). In the context of isolated rheumatic diseases of the mother, there is a risk that the development of the excitation conduction at the baby’s heart can be disturbed. This risk can be significantly minimized by treatment with dexamethasone and betamethasone.
The possible side effects that may occur during treatment with glucocorticoids depend strongly on the dosage, the type (tablet, ointment, spray) and the duration of the intake. It should be taken into account that the individual glucocorticoids have different potencies. Side effects are to be feared above all during long-term therapy with high-dose glucocorticoids in the form of tablets.
Nevertheless, the occurrence of side effects is very rare. During the first third of the pregnancy, high-dose, long-term therapy (more than 15 to 20 mg per day) carries the risk of developmental disruption for the child. The frequent occurrence of cleft lip and palate when taken between the 8th and 11th week of pregnancy is discussed.
There may also be indirect risks for the child, as the very high doses may promote gestational diabetes, high blood pressure or eclampsia. During the second and third trimesters of pregnancy, high-dose, long-term therapy carries the risk of growth disorders and premature birth. Low blood sugar levels in the baby’s blood, low blood pressure and electrolyte disorders may also occur in exceptional cases. In addition, there is a risk of adrenal cortex insufficiency at the end of pregnancy, as high glucocorticoid levels inhibit the natural production of cortisone in the baby‘s body.
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