Adrenal Steroids And Pregnancy

Adrenal steroids are teratogenic in animals. Although a relationship between steroid pharmacotherapy and cleft palate and other fetal abnormalities has been suspected in man, there is no doubt that many women taking a steroid throughout have both conceived and borne normal babies. Adrenal insufficiency due to hypothalamic/ pituitary suppression in the newborn occurs only with high doses to the mother. Dosage during pregnancy should be kept as low as practicable and fluorinated steroids are best avoided as they are more teratogenic in animals (dexa- and betamethasone, triamcinolone and various topical steroids, e.g. fluocinolone). Hypoadrenal women who become pregnant may require an increase in hydrocortisone replacement therapy by about 10 mg per day to compensate for the increased binding by plasma proteins that occurs in pregnancy. Labour should be managed as described for major surgery (below).

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