One of the chief concerns of pregnant women with inflammatory bowel disease (IBD) is the effect that medications to treat IBD may have on an unborn baby. For example, steroids such as prednisone are commonly used to treat IBD, and they carry a host of side effects.
It is preferable to not take any medications during pregnancy, but sometimes medications are clearly needed in pregnant women who have chronic conditions -- for the health of both the mother and the baby.
To find out more about how prednisone in particular affects an unborn baby, I turned to UpToDate, a resource for physicians and patients looking for in-depth medical information.
"Some studies have suggested that there may be a very small increased risk of cleft lip or cleft palate in the babies of mothers who took oral steroid medications during the first 13 weeks of pregnancy. Two studies found a slightly increased risk of premature delivery, and one study found a slightly increased risk of having a low birth weight baby. However, the researchers could not rule out the possibility that these effects were related to the woman's underlying medical condition rather than use of the drug."
What This Means for Women With IBD
Prednisone during pregnancy has been associated with cleft lip or palate, premature delivery, and low birth weight.
Oral clefts: There is a very small risk of a cleft lip or palate in babies born to women who take prednisone during the first trimester of pregnancy. However, it is unknown how much of this risk could actually be due to the underlying chronic medical condition that the mother has.
Premature delivery: Some studies have shown that pregnant women taking prednisone have a slight increase in delivering the baby early (preterm delivery). One study in women with lupus showed that women whose lupus was active and who also took more than 10 mg of prednisone per day had an increased risk of preterm delivery. However, one study of pregnant women with IBD showed that the medications used to treat IBD, such as prednisone, did not have any significant effect on preterm delivery.
Low birth weight: There is some evidence that prednisone may contribute to the risk of having a low birth weight baby. However, the same study that showed no effect of IBD medications on preterm delivery also showed that IBD medications had no effect on birth weight.
The evidence is somewhat conflicting, indicating that much is still unknown regarding the risks prednisone poses to an unborn baby. However, most studies show that the risks are low, and no studies on women with IBD have shown that prednisone presents a risk of major birth defects. Even so, it is recommended that prednisone only be used in cases where it is clearly need to treat the mother's IBD.
It's important to note that if you are on prednisone, it is very dangerous for you to stop taking the medication abruptly. If you are concerned, speak to your doctor. The decision to discontinue taking the medication should be made with consultation of your obstetrician and a gastroenterologist, preferably one who specializes in IBD and pregnancy.
Want to learn more? See UpToDate's topic, "Patient information: Inflammatory bowel disease and pregnancy," for additional in-depth medical information.
Peppercorn Mark A. "Inflammatory bowel disease and pregnancy." UpToDate. Accessed: September 2009.