Methylprednisolone in Pregnancy and Breastfeeding
      
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Methylprednisolone (Medrol®, Solu-Medrol®)
Glucocorticoid. 6-methyl derivative of prednisolone. Anti-inflammatory.
Molecular weight: 374.48
CATEGORY: C

Methylprednisolone crosses the human placenta [1].

Some studies suggest a possible increased risk of oral cleft when corticosteroids are used during the first trimester of pregnancy in humans [2, 3].

Methylprednisolone has been used to treat hyperemesis gravidarum during early pregnancy. Safari et al. treated 20 women for hyperemesis gravidarum beginning at  7 to 12 weeks with methylprednisolone 16 mg orally 3 times a day for 3 days, followed by a tapering regimen (halving of dose every 3 days) to none during the course of 2 weeks. Birth information was available for 12 patients. One patient delivered an infant with Smith-Lemli-Opitz syndrome at 35 weeks'. No birth defects were reported in the other  11 infants [4]

Yost NP et al., compared the outcomes of 56 pregnant women treated for hyperemesis gravidarum with methylprednisolone to a control group of 54 women who received a placebo. The gestational ages at randomization were between  8 to 14  weeks' . Women in the corticosteroid group received with methylprednisolone 125 mg IV followed by an oral prednisone taper (40 mg for 1 day, 20 mg for 3 days, 10 mg for 3 days, 5 mg for 7 days). During the trial there was one stillborn fetus, at 29 weeks,  in a woman who received corticosteroids. One woman in the placebo group delivered a premature infant  with microcephaly at 27 weeks. No other birth defects were reported [5].

The National Asthma Education Program Working Group on Asthma and Pregnancy does  not consider the indications for the use of methylprednisolone in the control of severe asthma exacerbations to be altered by pregnancy [6].

BREAST FEEDING: We were unable to locate studies specifically addressing the use of methylprednisolone during breastfeeding. Based on studies of prednisolone transfer to breast milk infant exposure to corticosteroid would be expected to be minimal  [7,8]. 

SEARCH LITERATURE

1. Anderson GG, Rotchell Y, Kaiser DG.Placental transfer of methylprednisolone following maternal intravenous administration. Am J Obstet Gynecol. 1981;140:699-701.MEDLINE
2. Rodriguez-Pinilla E and Martinez-Frias ML. Corticosteroids during pregnancy and oral clefts: a case-control study. Teratology. 1998;58:2-5.MEDLINE
3. Carmichael SL; Shaw GM: Maternal corticosteroid use and risk of selected congenital anomalies. Am J Med Genet 1999;86:242-4. MEDLINE
4. Safari HR, et. al., The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: a randomized, double-blind, controlled study. Am J Obstet Gynecol. 1998;179:921-4. MEDLINE
5. Yost NO et al. A randomized, placebo-controlled trial of corticosteroids for hyperemesis due to pregnancy. Obstet Gynecol. 2003;102:1250-4. MEDLINE
6. Clark SL. Asthma in pregnancy. National Asthma Education Program Working Group on Asthma and Pregnancy. National Institutes of Health, National Heart, Lung and Blood Institute.Obstet Gynecol. 1993;82:1036-40.MEDLINE
7. McKenzie SA, et al., Secretion of prednisolone into breast milk. Arch Dis Child. 1975;50:894-6. MEDLINE
8. Greenberger PA, et al. ,Pharmacokinetics of prednisolone transfer to breast milk.Clin Pharmacol Ther. 1993;53:324-8.MEDLINE

 

Created: 11/17/2000
Updated: 11/30/2002
Updated: 12/15/2003

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