Guillonneau M, Jacqz-Aigrain E
Unité de Pharmacologie Clinique, Hôpital Robert-Debré, Paris.
J Gynecol Obstet Biol Reprod (Paris). 1996;25(2):160-7.
There are many indications for steroids in pregnant women including asthma, chronic inflammatory diseases and disseminated lupus erythematosus. Prednisone and prednisolone, the preferred drugs, are inactivated by the placenta so that fetal exposure is minimal. The effect of corticosteroids on the fetus has been studied by a number of workers. The earliest studies in the sixties reported various adverse effects (prematurity, intra-uterine growth retardation), but cannot always be used to analyze the effect of steroid drugs, often used at uneffective doses versus that of the underlying pathology. In the more recent studies conducted since 1980, steroids were given at effective doses and show that maternal-targeted corticosteroids are more beneficial than detrimental for the fetus. Indeed, steroid drugs have no teratogenic effect in man and carry no risk of fetal intoxication at therapeutic doses. The long-term risk remains to be evaluated.
孕妇使用类固醇有多种适应症,包括哮喘、慢性炎症性疾病和播散性红斑狼疮。泼尼松和泼尼松龙是首选药物,它们会被胎盘灭活,因此胎儿接触到的药物量极少。许多研究人员对皮质类固醇对胎儿的影响进行了研究。60年代最早的研究报告了各种不良反应(早产、宫内生长迟缓),但这些研究结果不能总是用于分析类固醇药物的作用,因为当时使用的剂量往往无效,且混杂了潜在病理状况的影响。自1980年以来进行的最新研究中,类固醇是按有效剂量给药的,结果表明针对母亲的皮质类固醇对胎儿有益大于有害。事实上,类固醇药物对人类没有致畸作用,在治疗剂量下也不会有胎儿中毒的风险。长期风险仍有待评估。