Glucocorticoids and pregnancy

The use of glucocorticoids during pregnancy is challenging, as it requires balancing the therapeutic benefits for the mother against the potential risks to the fetus. Understanding their influence on fertility, and knowledge of the pharmacodynamics and pharmacokinetics of glucocorticoids during pregnancy is essential for the safe and effective management of these drugs. The paper presents a bibliographic review, using fulltext articles from the Hinari, and PubMed databases, as well as national and international clinical protocols regarding the use of glucocorticoids during pregnancy and their impact on intra- and postnatal development. The analysis of the selected articles revealed that systemic glucocorticoids in pregnancy are used for their anti-inflammatory, immunosuppressive and substitution purposes in case of deficiency. Another indication of systemic glucocorticoids is the treatment of severe infection with COVID-19, including during pregnancy. Evidence shows that prednisolone is compatible with pregnancy and is the corticosteroid of choice for the treatment of rheumatic conditions during pregnancy. Guidelines on antenatal glucocorticoid use state that where preterm birth is anticipated, pregnant women should be given intramuscular dexamethasone or betamethasone to reduce the risk of neonatal respiratory distress syndrome. At the same time, there is increasing evidence that some fetal glucocorticoid treatments are either ineffective or may lead to adverse outcomes, in addition to lasting epigenetic changes in many homeostatic links. Understanding the pharmacological properties, the underlying mechanisms of the beneficial effects of glucocorticoids, and the potential negative effects will help select the correct glucocorticoid according to the clinical situation with the improvement of fetal and maternal prognosis.