Prednisone
Prednisone is a glucocorticoid which acts as an immunosuppressant and anti-inflammatory medication. It inhibits and reduces the number of various immune cells and it’s widely used in autoimmune and inflammatory diseases.
The use of prednisone in patients with recurrent pregnancy loss (repeated miscarriages) has been studied and a significant improvement in the pregnancy and live birth outcome has been found. It has been noticed that prednisone increase the T-regulatory cells (important for maternal-fetal tolerance) and inhibits T-helper 1 cells. The dose of prednisone is adjusted based on immune testing.
In the past, it was thought that prednisone increases the risk of birth defects like cleft lip and cleft palate. However, recent studies have shown that there is no increased risk of cleft lip and palate associated with prednisone received in pregnancy. Maternal adverse effects in pregnancy include but not limited to high blood pressure, high blood sugar, abnormal liver and kidney function, bone density loss and risks of infection. Patients taking prednisone should be monitored very closely to minimize the risk of adverse effects.
Some of the studies that showed a significant improvement in the reproductive outcome:
- Skuladottir H et al. Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014 Jun;100(6):499-506.
- Gomaa MF et al. Combined oral prednisolone and heparin versus heparin: the effect on peripheral NK cells and clinical outcome in patients with unexplained recurrent miscarriage. A double-blind placebo randomized controlled trial. Arch Gynecol Obstet 2014; 290:757–
- Fawzy M et al. Treatment options and pregnancy outcome in women with idiopathic recurrent miscarriage: a randomized placebo controlled study. Arch Gynecol Obstet 2008; 278:33–
- Tempfer CB et al. A combination treatment of prednisone, aspirin, folate, and progesterone in women with idiopathic recurrent miscarriage: a matched-pair study. Fertil Steril 2006; 86:145.
- Tang AW et al. A feasibility trial of screening women with idiopathic recurrent miscarriage for high uterine natural killer cell density and randomizing to prednisolone or placebo when pregnant. Hum Reprod 2013; 28:1743.