I was pleasantly surprised when we got the information about our most recent protocol (before our appointment with the doctor) that the doctor had indicated he would be proscribing a steroid—dexamethasone. Dexamethasone, like prednisone, is a corticosteroid. (20mg of prednisone is roughly equivalent to 3mg of dexamethasone.) But I’ve read SO MUCH about the use of prednisone (or prednisolone) during pregnancy, and read very little about their cousin dexamethasone, so I was a little unsure why he picked dexamethasone over prednisone.
I had a very difficult time finding any medical journal articles comparing dexamethasone or prednisone for recurrent miscarriages.
One RE doctor’s website, when asked “The AEB center uses Dexamthasone, but I really do not know why the prefer it over the Prednisone” responded “90-95 percent of prednisone is broken down by the placenta , so very little gets to the baby. This is not the case with dexamethasone.”
Another blog suggested that dexamethasone was preferred on the front end, because it “calms” NK cells, while prednisone is preferred once pregnancy is established.
When I just limited my searching to the use of dexamethasone for miscarriage prevention, things got… interesting. The first hit was an article about using dexamethasone to TERMINATE pregnancies (in dogs—it was jarring to read “bitches”).http://www.ncbi.nlm.nih.gov/pubmed/9404290 YIKES. (Indeed, Google will suggest other searches you might like to run include “dog abortion.” Jeez.)
Then I ran across an Atlantic article suggesting the use of dexamethasone during pregnancy has some pretty serious risks:
The article suggests that “prenatal synthetic glucocorticoid exposure could permanently change the way a person's genetics will operate over his or her lifetime.” YIKES. That applies to prednisone as well, too, although prednisone does not appear to cross the placenta as much as dexamethasone. It reports that a Swedish study was halted because of severe adverse outcomes: “In mid-2012, the Swedish research team reported that they had gone to their ethics board to tell them they were shutting down their trial use. The Swedes have so far found 8 "severe adverse events" among 43 children exposed in utero. Problems among those exposed include mental retardation (3 cases among the 43 children), memory problems, and growth disorders.”
Also, it’s one of the steroids that can be used to speed up fetal lung development in case of risk of premature delivery: http://www.ncbi.nlm.nih.gov/pubmed/8960608
YIKES. No good medical journal articles suggesting dexamethasone is beneficial to treat miscarriages—other than its grouping as a steroid generally—and some pretty scary suggestions that it may mess with the fetus’s development.
So I have a meeting with my RE before we start any procedure, and I’m going to get some answers about why he would suggest dexamethasone, what dosage and for how long, and his thoughts on prednisone. I’m also going to give him one of the articles I found on prednisone.
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