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Key takeaways
Prednisone is a commonly prescribed corticosteroid that is generally considered safe during pregnancy and is often preferred over other options when treatment is needed.
It is favored because the placenta limits how much of the drug reaches the fetus, resulting in lower exposure compared with other steroids.
While prednisone carries some risks, leaving serious maternal health conditions untreated during pregnancy can pose greater health concerns for both the mother and the baby.
Prednisone is an oral corticosteroid used to treat a wide range of conditions, including asthma, lupus, rheumatoid arthritis, and other inflammatory or autoimmune disorders. It works by calming the immune system and reducing inflammation in the body.
If you are pregnant and taking prednisone, or were recently prescribed it, you may be wondering whether it is safe for the fetus. While caution is always important with any medication during pregnancy, prednisone is often the preferred corticosteroid in these cases and is commonly recommended when treatment is necessary. Experts explain why, and the risks to consider.
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Can you take prednisone while pregnant?
“Prednisone is commonly used during pregnancy and is generally considered safe when it’s medically necessary,” explains Diana Kolettis, MD, maternal fetal medicine specialist and associate program director of the Obstetrics & Gynecology Residency Program at Tufts Medical Center. “We use it to treat a variety of conditions like asthma, autoimmune diseases, and other inflammatory conditions.”
Prednisone and pregnancy are typically a safe combination. In fact, prednisone is actually the preferred corticosteroid for use in pregnancy, according to Dr. Kolettis. That said, like other prescription drugs, there are always risks and benefits to using any medication, especially during pregnancy.
Healthcare providers will typically recommend prednisone when the risk of not treating a particular health condition will be more harmful to the pregnancy or the fetus than not treating it. “I always emphasize that poorly controlled maternal disease, whether it’s asthma, an autoimmune condition, or another inflammatory disorder, may be far riskier to the mother and the pregnancy than the medication itself,” says Eran Bornstein, MD, vice chair of OB-GYN at Northwell’s Lenox Hill Hospital.
What are the risks of taking prednisone while pregnant?
One of the reasons that prednisone is considered a safer corticosteroid during pregnancy is that only small amounts of it cross the placenta. “The placenta acts as a natural filter, breaking down much of the drug before it crosses over,” Dr. Kolettis says. “Because of this, the overall risk to the baby is low, especially at typical doses.”
On the other hand, other corticosteroids, like dexamethasone and betamethasone, tend to cross the placenta much more easily, according to Dr. Kolettis. “These are generally used for specific fetal indications rather than for long-term treatment of maternal conditions,” she explains.
Still, although prednisone is the preferred corticosteroid during pregnancy, it is not entirely risk-free to either the mom or fetus.
Maternal risks
Like all medications, there are some risks to pregnant mothers when taking prednisone. Risks include the development of gestational diabetes, high blood pressure, infections, fluid retention, and mood changes. The risks are greater when taking high doses compared with low-dose treatment.
“These are similar to the risks seen in nonpregnant patients but are particularly important to watch during pregnancy,” Dr. Kolettis says. Importantly, these risks can be mitigated by using the lowest dose steroid to help the maternal medical issue, for the shortest duration, and by closely monitoring the pregnant woman for side effects.
Fetal risks
The most commonly discussed risks to babies are oral clefts (cleft lips and cleft palates), preterm birth, and low birth weight. However, many providers believe this association is outdated, as recent research has not shown causation between maternal prednisone use and fetal cleft lips or palates.
Recent studies don’t show an increased risk of oral clefts in mothers taking corticosteroids like prednisone during pregnancy. “Newer studies and evidence are conflicting on the actual role and causation of prednisone and steroids being linked to this,” says Dylan Huber, Pharm.D., pharmacy clinical coordinator at SAH Pharmacy inside Saint Anthony Hospital in Chicago.
The same is true of premature birth and low birth weight. “There is not much evidence of steroids contributing to these,” Dr. Huber says.
What can I take instead of prednisone during pregnancy?
Corticosteroids like prednisone aren’t the only option during pregnancy. Alternative medications depend on the medical condition you are being treated for, such as:
Asthma
If you have asthma, prednisone isn’t the only option. Safer alternatives are typically inhaled medications that do not systemically absorb, like oral prednisone. “Inhaled corticosteroids, like budesonide, are first-line and preferred because they act locally in the lungs with minimal systemic absorption,” Dr. Bornstein says.
Budesonide is typically used as a maintenance medication for asthma, meaning that it helps prevent asthma attacks from occurring in the first place. Albuterol, used for acute asthma exacerbations, is another safe option to consider, says Dr. Huber.
Autoimmune or inflammatory conditions
There are many treatment options for autoimmune or inflammatory conditions. “We often work closely with rheumatology or other specialists and may opt for steroid-sparing medications like Plaquenil, azathioprine, or, in some cases, certain biologic agents that have reassuring safety data in pregnancy,” Dr. Bornstein shares.
According to Dr. Huber, other alternative medications to consider include:
- Oral medications such as sulfasalazine and hydroxychloroquine
- Biologics like Humira or Cimzia
Keep in mind that although considering prednisone alternatives can be helpful, there is a place for prednisone in pregnancy that many of these medications can’t fulfill. “Prednisone is still an important and safe tool when we need it,” Dr. Kolettis says. “The use of prednisone is typically reserved for flares or when the control of the disease is inadequate.”
Managing chronic conditions during pregnancy
Medications aren’t your only options for managing conditions like asthma, autoimmune conditions, and other inflammatory diseases. For all conditions, an important management tool is avoiding triggers that cause flare-ups.
For instance, for asthma management, consider “avoiding airborne triggers such as dust, pollen, etc. and managing activities such as exercise if that may trigger exacerbations,” says Dr. Huber. “Acute infections, changes in weather, and stress are also things that can contribute to asthma flare-ups, so managing these as well is helpful to prevent exacerbations.”
The same concept applies to autoimmune and inflammatory bowel diseases. “For conditions such as IBS/Crohn’s and lupus, avoiding food/environmental triggers, managing stress, and getting appropriate sleep can all help prevent flare-ups,” Dr. Huber says. “Similarly, for other conditions such as rheumatoid arthritis, management of physical activity and rest is helpful, as well as using cold or warm packs.”
Above all, while these non-medical treatments can be helpful, they shouldn’t replace medication, if you need it, even during pregnancy. Whatever treatment options you are using, you should stay in touch with your medical care team to ensure that you are managing your conditions appropriately and staying healthy during your pregnancy.
The bottom line
Prednisone is usually safe to take during pregnancy and is recommended over other corticosteroids. It can be an important tool for managing health conditions during pregnancy, such as asthma, allergies, autoimmune diseases, and other inflammatory conditions. It’s often essential to treat these conditions when you have them, to ensure the safety and well-being of both you and your fetus.
Prednisone is safest when closely monitored by a healthcare provider. You should seek medical advice from your provider throughout treatment and reach out if you have any concerns.
“If you’re pregnant and prescribed prednisone, don’t hesitate to ask questions,” Dr. Kolettis emphasizes. “Open communication with your care team can help you feel confident and supported throughout your pregnancy.”
You should continue to stay in touch with your provider postpartum to answer any questions you may have about taking prednisone while breastfeeding.
- Label: prednisone tablet, DailyMed (2024)
- Maternal use of prednisolone is unlikely to be associated with neonatal adrenal suppression—a single-center study of 16 cases, European Journal of Pediatrics (2017)
- Prednisone/prednisolone, MotherToBaby (2024)
- Corticosteroid use and risk of orofacial clefts, Clinical and Molecular Teratology (2014)
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