Am J Perinatol 2007; 24(2): 079-082
DOI: 10.1055/s-2006-958162
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Pharmacokinetics of Corticosteroids during Pregnancy

Luis D. Pacheco1 , Labib M. Ghulmiyyah1 , Wayne R. Snodgrass2 , 3 , Gary D.V Hankins1
  • 1Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
  • 2Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
  • 3Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
29. Januar 2007 (online)

ABSTRACT

Glucocorticoids constitute one of the most frequently prescribed medicines during pregnancy. Their use is the mainstay for a variety of maternal and fetal indications, both in acute and chronic settings. The pharmacokinetics of corticosteroids during pregnancy remains poorly understood. Significant pharmacologic alterations occur secondary to the profound changes in the renal, gastrointestinal, and cardiovascular systems during human gestation. Additional research on this topic is a significant priority to increase therapeutic benefit while minimizing side effects for both the mother and fetus when corticosteroids are prescribed during pregnancy. Certain obstetrical conditions such as preeclampsia and multiple gestations are associated with different volumes of distribution and clearance rates of medications, adding further complexity to the therapeutic use of glucocorticoids. This article reviews the available literature, including the most significant physiologic alterations of pregnancy and basic concepts of glucocorticoid pharmacology. Finally, theoretical assumptions about the potential pharmacokinetic changes of glucocorticoids in pregnancy and their application to clinical settings are discussed.

REFERENCES

  • 1 Suarez-Kurtz G, Estrela R, Salvadori M C. Prednisolone.  Ther Drug Monit. 2004;  26 16-22
  • 2 Dildy G A, Belfort M A, Saade G R et al.. Critical Care Obstetrics. Malden, MA; Blackwell Science 2004
  • 3 Christofides N D, Ghatei M A, Bloom S R, Borberg C, Gillmer M D. Decreased plasma motilin concentrations in pregnancy.  Br Med J (Clin Res Ed). 1982;  285 1453-1454
  • 4 Pitkin R M, Witte D L. Platelet and leukocyte counts in pregnancy.  JAMA. 1979;  242 2696-2698
  • 5 Schwab M, Klotz M. Pharmacokinetic considerations in the treatment of inflammatory bowel disease.  Clin Pharmacokinet. 2001;  40 723-746
  • 6 Morris H G. Factors that influence clinical responses to administered corticosteroids.  J Allergy Clin Immunol. 1980;  66 343-346
  • 7 Katzung B G. Basic and Clinical Pharmacology. East Norwalk, CT; Appleton & Lange 1995
  • 8 Brunton L L, Lazo J S, Parker K L et al.. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York; McGraw-Hill 2006
  • 9 Rose J Q, Yurchak A M, Jusko W J. Dose dependent pharmacokinetics of prednisone and prednisolone in man.  J Pharmacokinet Biopharm. 1981;  9 389-417
  • 10 Kawai S, Ichikawa Y, Homma M. Differences in metabolic properties among cortisol, prednisolone, and dexamethasone in liver and renal diseases: accelerated metabolism of dexamethasone in renal failure.  J Clin Endocrinol Metab. 1985;  60 848-854
  • 11 Boekenoogen S J, Szefler S J, Jusko W J. Prednisolone disposition and protein binding in oral contraceptive users.  J Clin Endocrinol Metab. 1983;  56 702-709
  • 12 Meffin P J, Wing L MH, Sallustio B C et al.. Alterations in prednisolone disposition as a result of oral contraceptive use and dose.  Br J Clin Pharmacol. 1984;  17 655-664
  • 13 Magee M H, Blum R A, Lates C D, Jusko W J. Prednisolone pharmacokinetics and pharmacodynamics in relation to sex and race.  J Clin Pharmacol. 2001;  41 1180-1194
  • 14 Begg E J, Atkinson H C, Gianarakis N. The pharmacokinetics of corticosteroid agents.  Med J Aust. 1987;  146 37-41
  • 15 Thakker K M. Predicting the dose dependent bioavailability of hydrocortisone and chlorothiazide in humans.  J Pharm Sci. 1983;  72 577-578
  • 16 Harrison T W, Tatterfield A E. Plasma concentrations of fluticasone propionate and budesonide following inhalation from dry powder inhalers by healthy and asthmatic subjects.  Thorax. 2003;  58 258-260
  • 17 Moss T J, Doherty D A, Nitsos I et al.. Pharmacokinetics of betamethasone after maternal or fetal intramuscular administration.  Am J Obstet Gynecol. 2003;  189 1751-1757
  • 18 Petersen M C, Collier C B, Ashley J J et al.. Disposition of betamethasone in parturient women after intravenous administration.  Eur J Clin Pharmacol. 1983;  25 803-810
  • 19 Ballabh P, Lo E S, Kumari J et al.. Pharmacokinetics of betamethasone in twin and singleton pregnancy.  Clin Pharmacol Ther. 2002;  71 39-45
  • 20 Lo E S, Huttinot G, Fein M et al.. Direct immunoassay procedure for plasma dexamethasone with a sensitivity at picogram level.  J Pharm Sci. 1989;  78 1040-1044
  • 21 Hakkola J, Raunio H, Purkunen R. Detection of cytochrome P450 gene expression in human placentas in first trimester of pregnancy.  Biochem Pharmacol. 1996;  52 379-383

Labib M GhulmiyyahM.D. 

Department of Obstetrics and Gynecology, University of Texas Medical Branch

301 University Boulevard, Galveston, TX 77555-0587

    >