Role of Steroids in Pregnancy… A Life Saver
Steroids!! In pregnancy? No way! Aren’t they dangerous for mother and baby? Why should they be administered? How are the steroids useful?
You’ll be surprised to know the answer, it is a big YES for using steroids during pregnancy as they are safe and very beneficial for saving lives of premature babies. Womb is definitely a most safe and favorable place for a growing baby but sometimes the environment of womb becomes hostile for the growing baby or there are obstetrical emergencies where premature deliveries occur. There are 10% of women who spontaneously go into premature labor and deliver, for all such cases, only two doses of steroids and proper nursery care has proven a positive impact on premature baby survival rate.
The following information would give answers to most of queries about usage of steroids during pregnancy and help to save lives of babies:
What is the mechanism of action of steroids for fetal lung maturity?
Our lungs are lined with a thin layer of a liquid chemical called ‘Surfactant’ which helps in normal breathing process by preventing our lungs from collapsing. It’s production starts in babies after 37 completed weeks of pregnancy, therefore premature babies lungs lack it, once steroid injection is given to mother, it stimulates fetal lung cells to produce surfactant.
Which pregnant patients should receive steroid injections?
They are given to pregnant women with a risk of premature delivery to prevent respiratory distress problems in premature babies.
What are premature babies?
Babies born before 37 completed weeks of pregnancy are premature.
Who are high risk patients of premature delivery who should receive steroid injections?
Patients with disturbed blood supply through placenta (feeding pipe), in conditions like:
- High blood pressure
- Uncontrolled diabetes
- Kidney or heart disease
- Multiple pregnancy
- Intrauterine growth retardation
- Previous premature delivery
- History of urinary or pelvic infections
- Malnourishment
- Weak uterus
- Smoking, alcoholism or drugs
- Obstetrical emergency conditions leading to premature delivery
- Aabnormal bleeding
- Premature rupture of membranes
- Cord prolapses
- Malpresentation
How steroids are beneficial for baby?
We can save lives of majority of premature babies by promoting baby’s lung maturity and significantly reducing medical problems like:
- Breathing problems (respiratory distress syndrome – RDS)
- Systemic infections within first 48 hours
- Need of respiratory support
- Bleeding in brain
- Serious bowel infection (Necrotizing enterocolitis)
When it should be given?
It should be given between 24 and 34 weeks of pregnancy, the appropriate timing is decided by the concerned consultant.
What is the dose of steroids?
Only, 2 doses of Dexamethasone (steroid ) 12 mg, 12 hours apart are given intramuscular which can improve survival rates of the premature newborns.
Does it need to be repeated?
Those women who have elective or scheduled Cesarean delivery before 36 +6 days, dose may need to be repeated.
Does it require hospital admission?
No, it’s given in outpatient department.
What are its side effects?
Single dose of steroids does not appear to cause short or long term maternal or fetal side effects. The common temporary side effects on mother are palpitations, hot flashes, dizziness and hyperactivity (inability to settle or sleep). Steroids cause high blood sugar levels among gestational diabetics and patients of impaired glucose tolerance, which needs proper monitoring and adjusting dose of insulin, sometimes hospitalization is necessary.
In which cases it should be given carefully?
There are certain cases where it should be administered after a consultants opinion, such as:
- Generalized sepsis
- Tuberculosis
- Leaking membranes for more than 2 days
Steroids given to pregnant women with a risk of premature delivery can accelerate fetal lung growth and maturity and can save lives of newborn by preventing and lowering the life threatening complications.
Dr. Ayesha Azam Khan