Question 4. Are steroids associated with increased perinatal complications?

From Chapter 8 of the Philippine Consensus Report on Asthma 2004 by the Philippine College of Chest Physicians.
This guideline starts below.

Are steroids associated with increased perinatal complications?

Answer

Inhaled corticosteroids have no effect on pregnancy outcome and do not increase the risk to the fetus. However, the use of oral steroids for severe asthma during pregnancy may be associated with increased perinatal complications.

Summary of Evidence

Review of literature on human studies do not show any evidence of teratogenicity with the use of inhaled corticosteroids during pregnancy. The most published information is on beclomethasone, and it does not appear to have any adverse effect on pregnancy outcome and does not increase the risk to the fetus. Likewise, a study with more than 2000 patients did not show an increased rate of congenital malformations with the use of inhaled budesonide.

Among 293,948 births identified from 1995 to 1998 derived from the Swedish Medical Birth register, pregnancy outcomes were compared for mothers reporting asthma medication usage with those for women who reported no usage. Researchers found that 2,968 mothers who reported use of inhaled budesonide during early pregnancy gave birth to infants of normal gestational age, birth weight, and length; there was no increase in rate of stillbirths or multiple births. Because of this data, budesonide has been assigned a safety category B rating by the FDA. At present, all other inhaled corticosteroids are category C.

On the other hand, oral steroids have been associated with risk for pre-eclampsia in several studies. Whether or not this link represents a drug effect or is a marker of severity cannot be ascertained. The use of oral steroids during the first trimester has also been associated with oral cleft palate deformities and prednisone treatment throughout the pregnancy is associated with lower birth weights. The benefit of using oral steroids, when indicated, far outweigh the risk of uncontrolled asthma to the mother and fetus.