Steroids and Pregnancy in UC
In response to a recent blog on disease activity and UC, Jennifer wrote in with a good question about whether the use of steroid enemas would decrease potential risks to the fetus compared to oral steroid therapy in active colitis. My base answer to this question is that it would depend on the individual characteristics of a patient's disease. Some important considerations are:
1) Extent of disease - For women with mild disease limited to the sigmoid and rectum (so-called "proctitis" or "proctosigmoiditis") steroid enemas may be viable and reasonable option. There is a paucity of data on how much of the topical steroid is absorbed through the GI tact and transferred across the placenta to the fetus. The scientific literature generally agrees that if placental transfer of steroids from the enemas occurs, it is likely low. In this respect, steroid enemas can be viewed at least equally as safe as oral steroids, and theoretically may transfer less steroid across the placenta. Note, however, that data to answer this precise question are not available.
2) Severity of disease activity - As discussed in prior blogs, the number one risk factor for complications to the fetus is active disease. It cannot be stressed enough how important it is for measures to be taken to ensure quiescent disease during pregnancy. That being said, for women with moderate to severe disease activity the use of oral steroids for flares is advised because the benefit to the fetus outweighs the risks. This principle holds true even for women with proctitis or proctosigmoiditis - if their disease does not appear to be controlled with topical steroids, then treatment with oral steroids is advised.
3) Pregnancy trimester - Rectal steroids are felt to be appropriate in mild, limited rectosigmoid disease during the first 2 trimesters of pregnancy. The use of rectal steroids is not recommended during the 3rd trimester.
As there are unique aspects to every patient, readers are encouraged to discuss information from the blog with their health care providers to better understand how these issues may impact their individual care.