Prednisone and pregnancy?

[butterfly_warrior]

We're coming in to that time of year where my rheumatoid arthritis gets VERY unhappy. Normally I would take naprosyn on top of my salazopyrin and that has worked very well in the past. Unfortunately, my FS has taken me off my naprosyn while we are doing IVF - can't have any NSAIDs at all now.

I'll be seeing my rheumy next week. He really doesn't like to hear that I'm in pain and doing nothing about it. And to be completely honest my knees are getting so bad that I've got to start doing something!

I suspect that the rheumy is going to start talking prednisone again. I'm wondering if a low dose of prednisone started before things get too bad will be able to keep things from getting to unmanageable levels later on in Winter. I guess that's something to discuss with my rheumy when I get there.

The big question I have is whether prednisone will be safe to take while doing IVF and/or in the early stages of pregnancy? I don't think I'll be able to get the opinion of my clinic regarding prednisone until I'm actually in there once we've started a FET cycle. I have no access to a private phone at work, and this isn't the kind of thing I really want to discuss openly in the middle of a nosey staff room!

Anyone got information for me?

BW

[Visitor7]

I'm currently taking prednisolone for my asthma, and my dr asked before giving it to me if I was still b/f, which I'm not, and he said he wouldn't give it to me if I was. I'm having a look on the net ATM for more info on that.

ETA: found this from www dot drugs dot com

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Prednisolone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Steroid medicine can affect growth in children.

[anney]

BW,
Prednisone, along with a few other drugs is part of a protocol used in IVF, when there have been some miscarriages possibly due to immune issues. So prednisone itself when doing IVF is probably not a problem but I am not sure of the dosages that are involved. I believe it is usually taken up to the 12 week of pg. and then patients are weaned off it. I know a few people who have taken it and got pg. so I will see if I can find out what there dosage was.

ETA - 3 different people had different dosages:

Prednisolone 20mg once daily
Prednisone 5mg 3 times a day, 4 times after transfer
10mg daily Prednisone commencing three weeks before Puregon.

[butterfly_warrior]

Thanks, Anney and Jodi.

As nobody has yet been able to identify exactly what my arthritis is, I've always had the question in the back of my head that there may be an autoimmune problem with regards to maintaining a pregnancy, even though my rheumy assures me that all the tests have come back negative and it won't be a problem... there's still that worry there.

I have to admit that I'm terrified of the mood changes and the weight gain (been there, done that, don't want to do it again!), but I do need to do something to keep myself mobile, and I don't want to have to suspend the IVF treatment for 6 months until we hit weather where the arthritis is more manageable... but it sounds like it just may solve two problems (not that we know yet if there is in fact a second problem) at once.

I'll keep reading and researching, and hopefully I'll be able to make a fully informed decision next week.

Anney, it would be good if I could get some idea of the dosages involved... Although I will be making every possible attempt to keep my dosages as low as possible.

BW

[Lucy]

BW,

My SIL undertook IVF and she took 5mg 3 times a day, 4 times after transfer. I don't know the specifics of her treatment, but she now has a 7 year old little man, my nephew Timmo.

I have not undertaken fertility treatments, but I was on and off prednisone for some years to treat an autoimmune disease (Sarcoidosis). I was on very high doses of up to 70mg, weaning down to 5mg eventually. (Timing was such that I weaned in a wet cold Adeide winter, which was tough for a few months, but I swam a lot to break through the cycle, IYKWIM?)

Anyway, my Sarcoidosis physician indicated that prednisone would NOT hinder TTC attempts. Although it then took me 3 years to get pregnant. Of course I will never be sure if they were connected or not. A subsequent OB suggested they might.

Anyway, I am blabbing now, but it may be worth asking your rheumy about Sarcoidosis? The brief symptoms you describe sound achingly similar.......

[butterfly_warrior]

Lucy, are there any tests that can be done to diagnose sarcoidosis? I've been tested for everything possible, and have been negative for everything. The only thing that shows in my blood tests is an eleveted ESR. I've been given a diagnosis of serum-negative rheumatoid arthritis, which means bugger all, really! What we do know is that I have some sort of inflammatory process going on in my body. It can strike in any and all joints (knees and hands most commonly and usually the most severe, but I've had flares in my spine and my toes and everywhere in between), results in swelling and pain and makes me feel like I can't move even though range of motion isn't affected at all. There's no joint degeneration at all, even after 5 years of this (I feel so very, very fortunate in this!). Does any of that fit sarcoidosis?

The opinion on prednisone seems very mixed, from what I've found on the net so far. There are some who say it should NOT be taken in pregnancy as it crosses the placenta and may be related to an increased chance of babies having cleft palate. Others say it can't cross the placenta and is safe in pregnancy. While still others say that it can be really useful in preventing miscarriage in some conditions. Looks like I'll have to discuss this thoroughly with both the rheumy and the FS.

One thing that is worrying me slightly in all this - it appears to have an impact on blood sugar levels, and my insulin resistance is bad enough! That's probably why I gained so much weight on it last time... but I wasn't on metformin then.

BW

[Lucy]

some sort of inflammatory process going on in my body. It can strike in any and all joints (knees and hands most commonly and usually the most severe, but I've had flares in my spine and my toes and everywhere in between), results in swelling and pain

The problem is that yes, it sounds exactly like Sarcoid to me, but it also sounds like arthritis.

I presented with erythema nodosum (red infalmed nodules under the skin) on my shins and cronic pain in the joints (shins) initially, and my GP was, very luckily, very on the ball, and picked it as a trait of sarcoid, and so it was diagnosed quickly. But with out the lesions, it is a lot tricker.

The testing that I subsequently had (via a thoratic specialist) was extensive (my sarcoid was severe & dibilitating). This was back in '98, so things may have developed since then, but the intital tests were, from memory, blood tests (to check for elevated ACE) calcium levels, liver function and for immune antibodies.

I also undertook a 24 urine test to check for excess vitamin D. I can't remember the reasoning behind this, but often excessive vit D in the blood is a common sarcoid symptom.

I also had to undertake a whole range of breathing tests/lung function tests.

I FELT like I had joint degeneration, but I had none at all. Bizarre, to be in so much pain (internally & externally, around my shins, my colar bone and under my breast bone), to not be able to walk for days on end, but for the bones themselves to be totally healthy!?

You are right about the jury being out on prednisone/fertility. Its frustrating.

One thing to bear in mind is that if your issue is connected with an auto immune problem, pregnancy often "cures" the problem.

(When I eventually got pg with Olivia, I felt better than I had done in years. I recently had a scaroid specialist check up (with the whole rigmarole of testing) and my physician says it is totally abated (dormant) with a miniscule chance of return.............)

[rufalina]

One thing to bear in mind is that if your issue is connected with an auto immune problem, pregnancy often "cures" the problem.

I was going to say the same thing. I have multiple sclerosis, and I have been told that when pg it sould go into "remission"... I have also heard that prednisone is given to pg MS ladies during pregnancy, and often prior to giving birth if required, but have not yet had to put that to the test...

Good luck with your arthritis and working out a treatment...
xo

[butterfly_warrior]

I tried to reply again last night, but a database error ate it!

My rheumy is so convinced that pregnancy will give me relief that he's been encouraging me to get pregnant ASAP since I started seeing him. He at times suggested I arrange to have an "accident", and now here we are with IVF.

Lucy, I found a list of sarcoidosis symptoms that was grouped under the different body systems. I could say yes to some of the joint and muscle symptoms, and yes to some of the liver symptoms, but that's it. The liver problems I've had in the past appear to have resolved now - after 5 years of abnormal LFTs, I had a completely normal one at the last time my rheumy sent me for tests. He's trying to hold off on the testing with all the other tests we're doing for IVF now. I'll certainly ask if he has thought of it when I see him again, but I think it's unlikely.

My rheumy seems quite content to follow the line that while we don't know what it is, we do know what it isn't, and we know what it's doing. Looking at the treatments for sarcoidosis - plaquenil and methotrexate are on the list. My rheumy is using salazopyrin for me for the simple fact that plaquenil didn't work and I refuse point blank to go anywhere near methotrexate until after we've had children. The treatments seem fairly similar anyway. The other thing my rheumy also likes to ask me is does it really matter if we can't put a name to it when we've found a treatment that is mostly workign? I suspect that with the current flares, he's going to be even more eager for me to get our first child out of the way so he can medicate the hell out of me with methotrexate if it is still necessary after pregnancy.

The pain is so bad tonight that I was nearly in tears until the panadeine started to take effect... I really think prednisone is my only option at this stage. While it's not guaranteed to be safe, it certainly appears safer than my other options.

BW

[rufalina]

Hun.
I totally understand what you are going through in relation to juggling TTC/pg with an illness and need for medication. I sometimes feel like the pressure from Dr's (and from inside myself too) to medicate, make it so much hard to deal with the whole conception thing. It is another whole pressure added ontop of the other issues you are facing. So just know that you are not alone in this struggle....
Anyway, hope the prednisone helps you out. I know when I have needed it in the past the benefits totally outweigh the side effects of the drug, and I would take it anytime I need it without hesitation.
Hope you are able to get the pain under control.
xo

[Jocee]

Hello

I understand your concerns with regards to taking prednisone.

I took prednisone (10mg - 15mg) throughout my whole pregnancy with no problems. I was told by both my ob and rheumatologist that it was safe to take prednisone during pregnancy. It actually worked in my favour in the end as my baby had to be delivered 4 weeks early and my ob said that he would have given me steroids to help my babys lungs develop but being that I was already taking them I did not need any more.

I suffer from Lupus and have taken prednisone for over 5 years. I conceived within 5 months of trying. Not sure if that was just lucky or that prednisone does not effect fertility.

I also continued to take prednisone whilst breast feeding. My baby's pedeatrician also advised that there was no problem breast feeding and taking the prednisone.

There is quite a lot of information available on the net that says that prednisone is a safe medication for pregnancy and breast feeding.

Good luck.

[butterfly_warrior]

Thanks for the information, Jocee. It's good to know that others have had success with the drug in pregnancy.

I saw my rheumy a couple of weeks ago, and we decided that prednisone was the way to go. He started me on 10mg, and wants me to start reducing that dosage to the absolute minimum to keep things under control. The dose reduction will start tomorrow now that I've located my trusty pill-cutter! I'm very aware of the fact that prednisone is also used when auto-immune conditions are a factor in miscarriage - perhaps thinking that even on the low dose I'm on that I've got something else swinging things in my favour.

My rheumy was quite certain that the prednisone wouldn't cause problems, and later reading has since revealed that prednisone is often used as part of an IVF protocol. I forgot to tell my clinic I was back on it when I called to start the FET cycle. I probably should do that tomorrow when I talk to them about the antibiotics I'm having to take for my killer sinus infection.

Some days I feel like a walking pharmacy!

BW