Dexamethasone in pregnancy: what is it prescribed for?

Pregnancy is a period when it is necessary to be extremely selective about taking medications. After all, any, even the most "harmless" drug can cause irreparable harm to the developing fetus, as well as negatively affect the entire process of gestation. However, there are situations when it is impossible to do without certain medications: for example, the hormonal drug Dexamethasone is prescribed quite often during pregnancy, despite the fact that the instructions do not recommend its use in this period. Why does this happen, and how does Dexamethasone affect the woman's body and the development of the unborn child?

Dexamethasone when planning pregnancy

Dexamethasone is a synthetic analogue of the adrenal cortex hormone. It stabilizes the production and metabolism of the corresponding hormones, so it is suitable for the correction of hyperandrogenism - increased levels of androgens in the blood. Very often, it is the imbalance of these hormonal substances, which are also called "male", that leads to the development of infertility or spontaneous abortion.

It often happens that a woman is prescribed Dexamethasone when planning a pregnancy, and then continues treatment until the birth of the child.

Patients who are worried about such a prescription are reassured by specialists: the dose of Dexamethasone prescribed by the doctor is not so large as to cause negative reactions from the woman's body or the fetus. The hyperandrogenism condition itself is much more dangerous. Therefore, if necessary, the drug is taken on the recommendation of a doctor - after passing all the required tests.

Hyperandrogenism is determined using the 17KS test: if values exceeding the norm are detected, then Dexamethasone is prescribed to normalize testosterone production.

As during pregnancy, the medication is used in a course of treatment, and the dosage is selected individually.

Can you take Dexamethasone during pregnancy?

Most often, Dexamethasone is used during pregnancy to stimulate the baby's pulmonary system or to prevent premature birth. If premature labor begins, the doctor administers special medications to stop it, after which he additionally administers Dexamethasone. A timely injection allows the lungs to prepare for breathing, even if the baby is premature: thanks to this, the baby will be able to breathe on his own immediately after birth.

However, preparing the lungs is not the only reason why doctors actively use Dexamethasone during pregnancy. Often, the period of gestation is interrupted due to increased production of androgens in the female body - male hormonal substances. To normalize their production and prevent interruption, Dexamethasone is used.

It is advisable to use the drug if the fetus has a rare deficiency of adrenal cortex hormones. Thus, with the help of Dexamethasone, it is possible to prevent the development of respiratory diseases in the baby.

Any adequate doctor will not administer a hormonal drug without appropriate indications. The prescription is made taking into account possible side effects and contraindications. Dexamethasone often comes to the rescue if the health of the mother and baby is in danger. In such a situation, the doctor may not even take into account the presence of contraindications.

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Indications Dexamethasone in pregnancy

Excessive androgen production is not the only indication for which Dexamethasone is used. During pregnancy, the medication may be prescribed:

• with a sharp drop in blood pressure;
• in case of heart attack, dangerous blood loss, burn injury;
• in case of severe intoxication;
• in the development of sepsis, purulent meningitis;
• in case of severe manifestations of toxicosis in the later stages;
• with allergic dermatosis;
• in tumor processes, cerebral edema;
• in case of pneumonia.

In case of multiple pregnancy or if there is a risk of premature birth, Dexamethasone may be prescribed during pregnancy to open the baby's lungs. If there is no threat of premature birth, then there is no need to use the drug. Dexamethasone prophylaxis during pregnancy is carried out in the amount of 6 mg four times every 12 hours at the first signs of premature onset of labor.

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Pharmacodynamics

Dexamethasone is a representative of semi-synthetic corticosteroids with glucocorticoid activity. During pregnancy, the drug demonstrates anti-inflammatory and immunosuppressive activity, affects the quality of energy and glucose metabolism, affects the factor stimulating the hypothalamus and the trophic hormone of the adenohypophysis.

The principle of action of glucocorticoid drugs has not been fully studied. Presumably, they act at the cellular level. There are a pair of receptor systems in the cellular cytoplasm. By connecting with glucocorticoid receptors, corticoids exhibit an anti-inflammatory and immunosuppressive effect, and correct glucose metabolism. And by connecting with mineralocorticoid receptors, sodium, potassium metabolism, and water-electrolyte balance are regulated.

The active glucocorticoid dissolves in lipids and easily enters cellular structures through the cell membrane.

Dexamethasone together with catecholamines, insulin and glucagon ensures the processes of energy conservation and utilization. The liver activates the formation of glucose and glycogen. In muscle and other peripheral tissues, the mode of amino acid mobilization and careful use of glucose is "switched on": these substances are necessary for intrahepatic gluconeogenesis processes.

Dexamethasone increases renal blood circulation and the rate of glomerular filtration, inhibits the synthesis of vasopressin, and potentiates the removal of acids from the body. At the same time, contractile activity of the heart muscle and the tone of peripheral vessels increase.

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Pharmacokinetics

Peak concentrations of Dexamethasone are detectable within five minutes of intravenous infusion and within 60 minutes of intramuscular injection.

When administered intravenously, the drug begins to act immediately, and when administered intramuscularly, after eight hours. The period of action of the active component after intramuscular injection can range from 17 to 28 days.

Dexamethasone phosphate is converted to dexamethasone in the serum and joint fluid fairly quickly. In the serum, about 77% is bound to albumin. Metabolism occurs mainly in the liver, to a lesser extent in the kidneys and other tissues.

The biological half-life can range from 24 to 72 hours. Excretion occurs primarily with urine.

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Dosing and administration

Dexamethasone is available:

• in tablet form (0.5 mg);
• in the form of a solution in ampoules for intramuscular and intravenous injections (4 mg/ml);
• in the form of eye drops;
• in the form of an eye suspension.

The dosage regimen is set individually, taking into account the indications, the patient’s well-being and her reaction to the treatment.

In urgent emergency situations, dexamethasone is administered intravenously slowly (either by jet injection or drip). In normal practice, the medication is more often administered as intramuscular injections. To dilute the solution for intravenous infusion, use a physiological solution of NaCl or a 5% glucose solution.

Dexamethasone in intramuscular injections is prescribed in an individually selected volume: at first, a slightly overestimated dose of the drug is administered, then this amount is gradually reduced to the optimal and most effective dose. The average dosage can be from 0.5 to 9 mg of the drug per day. An intravenous drip is used in case of premature onset of labor, when the goal is to open the lungs of a baby with an incompletely formed respiratory system. Sometimes additional administration of the drug may be required immediately before delivery.

How many times can Dexamethasone be injected during pregnancy? There is no clear answer to this question, since the prescription is always individual and is selected for each specific case separately. Some women are given the medication once, while in other situations, treatment is required throughout the entire pregnancy. Long-term treatment is usually carried out using the tablet form of Dexamethasone.

The tablets are taken in the morning or before bedtime, or twice a day, in an individually determined amount. The average single dose of the drug is ½ a tablet. The most common treatment regimen is when a woman initially takes an overdose, which is gradually reduced and, if necessary, reduced to "zero". If a long-term treatment period is expected, intramuscular injections are administered first, then the patient is transferred to maintenance therapy with Dexamethasone tablets.

There is also a form of the medicine in the form of an ophthalmic solution. Dexamethasone eye drops are not prohibited during pregnancy, but they are used only with a doctor's recommendation: for iritis or iridocyclitis, bacterial conjunctivitis. The drops do not have a systemic effect, and their local use does not harm pregnancy and the fetus. Dexamethasone is used up to 3 times a day, 1-2 drops in the affected eye (unless the doctor has prescribed otherwise).

In case of bronchitis, pneumonia, bronchial asthma, laryngeal edema, the doctor may recommend inhalation administration of the drug. Inhalations with Dexamethasone during pregnancy are allowed, but the procedures are performed under medical supervision, and the entire period of inhalation treatment should not exceed 7-10 days.

Eye drops, or suspension drops, are allowed to be dripped into the nasal cavity in some cases - for example, with sinusitis, nasopharyngitis, hay fever. Dexamethasone in the nose during pregnancy can alleviate the course of allergic rhinitis, relieve inflammation and intoxication. However, such drops cannot be used more than 3 times a day, and more than seven days in a row. Moreover, the medication should not be used without good indications - for example, with a common cold, when it is quite possible to use safer drugs.

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Cancellation of treatment

Many women who have to take the drug for a long time worry: how will the withdrawal of Dexamethasone occur during pregnancy? Indeed, this question is relevant, since it is impossible to abruptly stop treatment with this medication. Dexamethasone is withdrawn as smoothly as possible, moving to ¼ of the usual dosage over 10 days. Why is this necessary? The point is that the human body independently produces hormones similar in structure to Dexamethasone. Against the background of treatment with the drug, its own production of the hormone is suppressed: the feedback principle is activated. With abrupt withdrawal of therapy, the body does not have time to adapt to the disturbed hormonal status. As a result, hypocorticism develops. Manifestations of such a pathological condition are that previously existing problems quickly worsen, laboratory parameters worsen, and blood pressure changes are observed. To avoid all this, it is necessary to be careful when stopping taking Dexamethasone.

Sometimes, when the threat of miscarriage has been removed, the medication is discontinued and then a repeat course of Dexamethasone is prescribed during pregnancy. This should not be frightening: repeat treatment can be offered approximately 3-4 weeks after the first and is considered safe.

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Dexamethasone at different stages of pregnancy

Let's sum it up briefly. Dexamethasone can be used in clinical practice in the following situations:

• Danger to the woman's life. Dexamethasone can be included in the resuscitation scheme in case of a severe allergic process, cerebral edema, and also in case of another life-threatening condition developing (bronchospasm, complicated attack of bronchial asthma).
• Threat of miscarriage. Dexamethasone is prescribed in early pregnancy to prevent premature termination of the gestation process, or to slow down such termination at the initial stage of its development (if the cause of such pathology is hyperandrogenism - increased production of male sex hormones).
• Risk of premature birth. If there is a risk that the baby will be born prematurely and will be premature, then Dexamethasone is connected to accelerate the adaptation of the baby's respiratory system to independent breathing function.
• Fetal developmental disorders. Dexamethasone will be prescribed in late pregnancy without fail if the fetus is diagnosed with congenital intrauterine hyperplasia of the adrenal cortex. This is a relatively rare pathology that requires mandatory drug correction.
• Autoimmune diseases in women. Dexamethasone is included in the prescription scheme during pregnancy if a woman is diagnosed with complicated dermatosis, connective tissue diseases, rheumatoid arthritis, severe endocrine disorders.
• Malignant pathologies during pregnancy. Dexamethasone is used as a drug that inhibits the division processes of atypical cells.

In some cases, the doctor includes Dexamethasone in the treatment regimen as a preventive measure to prevent relapse of autoimmune pathology. Such a prescription is considered not so much in terms of the negative impact on the course of pregnancy or fetal development, but in terms of preventing a sharp exacerbation of the disease, which can cause much greater damage than the use of the drug.

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Contraindications

Dexamethasone will not be prescribed during pregnancy if the patient suffers from at least one of the following conditions:

• ulcerative processes in the digestive tract (in the stomach, intestines);
• gastritis, gastroduodenitis;
• systemic osteoporosis;
• acute infectious processes;
• HIV infection;
• psychotic disorders;
• cardiac pathologies;
• tendency to hypertension;
• increased intraocular pressure;
• diabetes mellitus;
• kidney stone disease;
• overweight;
• chronic renal and/or hepatic insufficiency;
• thyrotoxicosis.

The list of contraindications is quite extensive, so the doctor must find out all possible painful conditions in a woman so that Dexamethasone during pregnancy has only a positive effect.

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Side effects Dexamethasone in pregnancy

The severity of side effects during treatment with Dexamethasone depends on the dose of the drug taken. As the patients themselves say, the most common adverse effects are:

• metabolic changes (increased sweating, swelling, increased fat mass mainly in the upper half of the body, increased levels of calcium, potassium, and sodium in the blood);
• endocrine changes (hypofunction of the adrenal glands, increased sensitivity to sugar-containing products);
• changes in the central nervous system (neuroses, convulsions, disorientation, migraine-like pain, dizziness, depressive states, sleep disorders);
• digestive disorders (nausea, bloating, changes in appetite);
• disorders of the heart and blood vessels (bradyarrhythmia, thrombosis, cardiac failure);
• allergic processes;
• osteoporosis;
• withdrawal syndrome.

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Overdose

Overdose is rare and occurs in an acute form: only isolated cases have been recorded so far.

As a rule, an excess of the drug manifests itself in an increase in side effects - most often, Cushing's syndrome develops.

A specific antidote has not been determined to date. Treatment is carried out taking into account the identified symptoms, and supportive drugs are also prescribed.

Hemodialysis is considered ineffective and does not accelerate the removal of Dexamethasone from the circulatory system.

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Interactions with other drugs

Dexamethasone is not mixed in the same syringe or drip system with any other medications, but only with physiological NaCl solution or 5% glucose solution.

Dexamethasone should not be taken orally with nonsteroidal anti-inflammatory drugs to avoid irritating stress on the digestive system.

Macrolides, Ketoconazole can increase the concentration of Dexamethasone in the blood plasma. Phenytoin, Ephedrine, Phenobarbital - on the contrary, reduce the effect of the drug.

Dexamethasone reduces the therapeutic effect of antidiabetic and antihypertensive drugs, but enhances the activity of heparin and albendazole.

When used in combination, the effectiveness of coumarin anticoagulants may be impaired.

Duphaston and Dexamethasone are drugs that are often prescribed together. This combination may slightly alter the half-life of the glucocorticoid and enhance its biological effect. The clinical significance of this effect has not been determined.

The combined use of Dexamethasone and Ritordin during labor is prohibited, as this may cause pulmonary edema in the mother.

The combination of Dexamethasone and Thalidomide can cause toxic epidermal necrolysis.

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Storage conditions

Dexamethasone is stored in normal room conditions, in rooms with a temperature regime from +15 to +25°C, away from children, direct sunlight and heating devices. The medicine should not be frozen.

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Shelf life

Ampoules with Dexamethasone can be stored for up to five years.

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Analogues: what can replace Dexamethasone during pregnancy

Dexamethasone is a synthetic glucocorticosteroid and is a methylated derivative of fluoroprednisolone. The drug interacts with certain cytoplasmic receptors, forming a system that induces protein synthesis.

Dexamethasone is involved:

• in protein metabolism, reducing the number of plasma globulins, increasing the formation of albumins in the kidneys and liver, accelerating protein catabolism in muscle tissue;
• in fat metabolism, increasing the production of triglycerides and higher fatty acids, redistributing fat in the body;
• in carbohydrate metabolism, increasing the absorption of carbohydrates in the digestive system, stimulating glucose-6-phosphatase, activating phosphoenolpyruvate carboxylase and the production of aminotransferases;
• in water-salt metabolism, retaining sodium ions and water, stimulating the excretion of potassium ions, reducing the absorption of calcium ions from the digestive tract, lowering the degree of mineralization of bone tissue.

The following medications are considered structural analogues of Dexamethasone:

• Decadron
• Dexazone
• Dexona
• Maxidex

The hormonal drug Metipred, often prescribed during the period of preparation of the female body for pregnancy or during gestation, does not belong to structural analogues, since its active substance is methylprednisolone. These medications are not interchangeable, have different effectiveness in different pathological spectra.

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Feedback on use

Usually, reviews on the Internet are left by women who have encountered the need to use Dexamethasone during pregnancy or when planning it. The need to take the medication almost always justifies itself: expectant mothers manage to successfully carry a child who is born without respiratory system disorders.

Positive feedback from patients confirms the opinions of doctors who do not advise neglecting the use of Dexamethasone if there are real reasons for its prescription. A medical specialist who prescribes this drug always weighs all the risks and dangers, takes into account contraindications: there is no doubt about this, because the doctor is fully responsible for the life and health of the woman and her future baby.

The use of Dexamethasone during pregnancy has been practiced for many years, and its effects on the body have been studied thoroughly enough. Therefore, such treatment can be considered safe if it is really necessary.