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Tell your doctor if you are thinking of becoming pregnant or find you are pregnant, and you are taking steroids. Because they are effective treatment, many experts now feel steroids can be taken during pregnancy as there may be a greater risk to the baby if the woman does not take effective treatment and is unwell from her IBD. Studies suggest active IBD at the time of conception and delivery may increase adverse outcomes, including spontaneous abortion and pre-term delivery, making it important to have effective treatment for active IBD.
Guidelines consider steroids taken during pregnancy to be of low risk to babies. While steroids can cross the placenta to reach the baby they rapidly become converted to less active chemicals.
Experts prefer prednisone, prednisolone, and methylprednisolone since they are more efficiently broken down by the placenta than dexamethasone or betamethasone. Maternal prednisolone doses of up to 40 mg daily are considered unlikely to affect the baby.
While some studies have shown a small increase in the risk of cleft lip and palate in babies born to women taking steroids in the first three months of pregnancy, other studies have not reported this finding. Palate formation is complete by week 12 so there are no risks of cleft lip and/or palate after this. Less is known about budesonide, but a small study of eight pregnant women did not find an increased risk of adverse outcomes.
There have been isolated reports of babies born with adrenal suppression when mothers took steroids late in pregnancy. So if you are taking steroids at the time of delivery be sure to let your health care team know as your baby may need a tapering course of steroids after birth.
In women taking steroids for other conditions (not IBD), an increase in maternal pregnancy complications (such as high blood pressure and diabetes) have occasionally been seen.
Much less is known about the effects of long-term steroids on male fertility and effects on their offspring. One study showed steroids can cause reversible decreases in sperm counts and motility, another found no link between steroid treatment and infertility.
Steroids are generally considered safe for use by breast feeding mothers. Although a small amount of the drug may pass to the baby, studies have found no harmful effects. Recommendations suggest that where possible women (especially those on high doses) should wait four hours after taking steroids before breast feeding. High doses of steroids used in other conditions have occasionally led to temporary loss of the mother’s milk supply.
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