Netherlands: Study on Prednisone Use During Pregnancy

Findings from a recent study, published in Clinical Rheumatology, have provided reassurance that in utero (low dose) exposure to prednisone does not increase the risk of insulin resistance in children at the age of about 7 years.

The findings are significant keeping in view the increasing worldwide use of prednisone during pregnancy. The researchers further add that to evaluate if insulin resistance remains absent, there is a need for future research.

Background

Over the past decades, long-term corticosteroids have been increasingly used during pregnancy. Corticosteroids are given in cases where an auto-inflammatory disease like rheumatoid arthritis (RA) is too active. Many previous studies have shown that long-term use of corticosteroids in pregnancy is tied to adverse maternal and fetal outcomes, like shorter gestational age, preeclampsia, rapid catch-up growth, and lower birth weight. The rapid catch-up growth and lower birth weight could impact insulin resistance in later life.

Study Objective

Against the above background, Florentien D. O. de Steenwinkel, Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands, and colleagues aimed to determine whether prednisone use in pregnant women with RA induces insulin resistance in offspring. They made the hypothesis that exposure to synthetic glucocorticoids in utero increases insulin resistance in children.

Methodology

For this purpose, the researchers included one hundred three children following the participation of their mothers in a prospective cohort study on pregnancy and rheumatoid arthritis. 42 children were exposed in utero to prednisone and 61 were non-exposed. HOMA-IR (homeostasis model of assessment insulin resistance) and serum lipid and adiponectin levels were used to assess insulin resistance after correcting for body fat distribution.

Findings

• Daily use of an average of 6 mg prednisone gave no difference in mean HOMA-IR between the children who were exposed to in utero prednisone (1.10) and those non-exposed (1.09).
• The researchers found no difference in body fat distribution, mean adiponectin level, or lipid levels such as fasting triglyceride, total cholesterol, or high-density lipoprotein.

Conclusion

To conclude, the use of long-term corticosteroids in pregnant women with rheumatoid arthritis has no increased risk for insulin resistance in the offspring.

"The findings are reassuring because of the increasing worldwide use of prednisone during pregnancy," the researchers wrote in their study. "Further study should investigate if the insulin resistance remains absent in the future."

"Exposure to low-dose of synthetic glucocorticoids in utero have no higher risk for insulin resistance at the age of approximately 7 years," they conclude.

Reference

de Steenwinkel, F.D.O., Dolhain, R.J.E.M., Hazes, J.M.W. et al. Does prednisone use in pregnant women with rheumatoid arthritis induce insulin resistance in the offspring?. Clin Rheumatol (2022). https://doi.org/10.1007/s10067-022-06347-0