Corticosteroids, Pregnancy, and HELLP Syndrome: A Review

Corticosteroids are potent antiinflammatory and immunosuppressive drugs, which are used in the treatment of a wide range of medical disorders. During pregnancy, several corticosteroids are administered for maternal as well as fetal reasons. Prednisone and prednisolone show limited transplacental passage and are thus used for treatment of maternal disease. Dexamethasone and betamethasone, drugs that can easily cross the placenta, are more suitable for fetal indications. During the last decade, administration of corticosteroids was introduced in the treatment of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome), a severe form of preeclampsia unique to human pregnancy. Several randomized, controlled trials as well as other prospective and retrospective studies have been performed to investigate this beneficial effect of corticosteroids on biochemical measures and clinical signs. This review discusses the characteristics of corticosteroids in humans and details the use of corticosteroids during pregnancy. A review of literature on the effect of corticosteroids on HELLP syndrome is given and possible mechanisms of action are discussed. TARGET AUDIENCE:Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES:After completion of this article, the reader should be able to compare the relative strength of the commercially available steroids, to outline the pharmacologic characteristics of glucocorticoids in humans, to compare the anti-inflammatory characteristics of corticosteroids, to explain the changes in glucocorticoid metabolism during pregnancy, and to list the effects of corticosteroids on the fetus.