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CORTICOSTEROIDS USE IN PREGNANCY


About Authors:
Patel Brilina M*, Yadav Nisha D, Maheta Payal, Arora Bhoomi
Institute of clinical research India,
Ahmedabad,
Gujarat, India
*patelbrilina@gmail.com

Abstract:
Corticosteroids, often referred to as steroid medications, contain man-made versions of the hormone cortisol. Corticosteroids are mainly used to relieve inflammation. Inflammation occurs when the immune system causes part of the body to become swollen, red and filled with fluid in response to an infection. The immune system is the body’s natural defence against infection and illness. Steroids form an important component in pregnancy to reduce the inflammation and are used since very long time for different conditions in different forms. Though very few molecules are used since very long time. Now increase knowledge in uses of corticosteroids in pregnant women who suffer from asthma, skin diseases, rheumatoid arthritis etc.

Reference Id: PHARMATUTOR-ART-1350

Introduction:
Corticosteroids refer to a group of hormones made within the adrenal cortex. Since these hormones play a critical role in maintaining carbohydrate reserves, they are often referred to as glucocorticoids. The excess or deficiency of these hormones affects virtually every tissue in the body.  It is tightly regulated by the central nervous system, which is very sensitive to negative feedback by the circulating cortisol and exogenous (synthetic) corticosteroids[1]. About fifty years ago corticosteroids were synthesized for their anti-inflammatory and immuno -suppressive properties[2] so it has a wide range of clinical uses. Corticosteroids are generally safe to use in pregnancyto reduce the immune response in allergic or inflammatory diseases, such as asthma, lupus, rheumatoid arthritis, or skin diseases. Other indications include: promoting fetal lung maturity, treating infertility and maintaining pregnancy, or as replacement hormone therapy[3]. Corticosteroids are available alone or in combination with other drugs for systemic, inhaled, and topical use. Systemic corticosteroids are used for autoimmune and inflammatory conditions. Inhaled steroids are now first-line treatment for asthma. Topical corticosteroids are frequently used to treat allergic and inflammatory dermatologic diseases, such as atopic dermatitis and psoriasis. Now we will focus on recent progress in our understanding of use of corticosteroids in pregnant women who are suffering from asthma, lupus, rheumatoid arthritis, or skin diseases etc.

The primary mechanism of action of corticosteroids is at the cellular level. These drugs appear to bind to intracellular receptors, alter gene expression and ultimately regulate cellular processes[4,5]. Their anti-inflammatory effect results from several different factors including inhibition of phospholipase, alterations in lymphocytes, inhibition of cytokine expression and stabilization of the cellular membrane [6]. Corticosteroids inhibit the action of phospholipase and thus prevent the formation of arachidonic acid and subsequently the inflammatory mediators.

Use of corticosteroids in different diseases in pregnancy:
Asthma may be the most common potentially serious medical condition to complicate pregnancy[7]. Asthma is a chronic inflammatory disease of the airways that is characterized by increased responsiveness of the tracheobronchial tree to multiple stimuli[8]. Asthma-related morbidity and mortality rates in pregnant women are comparable to those in the general population. The mortality rate from asthma in the United States is 2.1 persons per 100,000[9]. Poor control of chronic asthma and exacerbation of acute asthma during pregnancy can result in adverse maternal and fetal outcomes, such as hypoxia, low birth weight, and intrauterine growth restriction[10,11].Inhaled corticosteroids used to treat asthma include beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone [12]. These drugshelp to control the swelling of the airways in the lungs and reduce mucus production so that asthma attacks are less likely. Inhaled corticosteroids improve the symptoms and are helpful in the management of asthma and thus can be used comfortably during pregnancy[13]. Commonly used systemic corticosteroids include prednisone, cortisone, and the active metabolites of prednisone and dexamethasone. Corticosteroids cross human placenta [14].The increased incidence of low birth weight and stillbirths reported in fetuses exposed to corticosteroids can often be linked to the conditions for which the mothers were given the drugs[15].Prednisone during pregnancy has been associated with cleft lip or palate, premature delivery, and low birth weight[16]. Rodríguez-Pinilla E, Martínez-Frías MLdone the study of 1184 cases of cleft lip suggested a possible association with oral corticosteroid treatment[17].Of the five affected pregnancies in the latter study, two were complicated by multiple congenital abnormalities and in another case the mother was taking only replacement steroids for Addison's disease. Thus, only two pregnancies (no more than control) were complicated by isolated cleft lip in women taking therapeutic doses of corticosteroids. A larger case-control study of 20,830 cases of congenital abnormality revealed no association between the rate of different congenital abnormalities and corticosteroid treatment in the second and third months of gestation[18]. An increased risk of pregnancy induced hypertension and pre-eclampsia has been reported in asthmatic women treated with oral corticosteroids[19,20,21].Inhaled corticosteroids are currently recommended as part of routine management of moderate-to-severe chronic asthma during pregnancy[22].

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