The transplacental passage of prednisolone in pregnancies complicated by early-onset HELLP syndrome.

Abstract

During pregnancy the placental 11beta-hydroxysteroid dehydrogenase 2 (11beta-HSD2) enzyme inactivates prednisolone by interconversion into prednisone, protecting the fetus from high levels of prednisolone. Recent reports suggest decreased placental 11beta-HSD2 activity in pregnancies complicated by preeclampsia. The purpose of our investigation was to study the transplacental passage of prednisolone in patients suffering from early preterm HELLP syndrome, a severe complication of preeclampsia. We examined the maternal and umbilical cord plasma concentration of prednisolone in nine women receiving 50 mg of prednisolone twice a day. Samples were obtained during caesarean section at a gestational age between 27 and 31 weeks. Mean fetal concentration was 10-fold lower as compared to maternal prednisolone concentration (mean+/-SD 52.8 nmol/L+/-27.0 vs. 477.5 nmol/L+/-300, p<0.01). A significant correlation was found between the last dose of prednisolone to delivery interval and the fetal prednisone concentration (Spearman's correlation coefficient r=-0.946, p<0.000). Our data demonstrate unimpaired placental 11beta-HSD2 activity in patients suffering from HELLP syndrome at early gestational age as shown by both a 10-fold lower fetal prednisolone concentration as compared to the mother and a strong correlation between the last dose of prednisolone to delivery interval and the fetal prednisone concentration. Prednisolone may therefore have less effect on the fetus than betamethasone or dexamethasone.

• Authors: P J van Runnard Heimel, A F A M Schobben, A J M Huisjes, A Franx, H W Bruinse
• Journal: Placenta (Placenta) Vol. 26 Issue 10 Pg. 842-5 (Nov 2005) ISSN: 0143-4004 [Print] Netherlands
• PMID: 16226134 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Anti-Inflammatory Agents
• Prednisolone
• 11-beta-Hydroxysteroid Dehydrogenase Type 2
• Prednisone

Topics

• 11-beta-Hydroxysteroid Dehydrogenase Type 2 (metabolism)
• Anti-Inflammatory Agents (blood, pharmacokinetics, therapeutic use)
• Female
• Fetus
• HELLP Syndrome (drug therapy, metabolism)
• Humans
• Infant, Newborn
• Maternal-Fetal Exchange
• Prednisolone (blood, pharmacokinetics, therapeutic use)
• Prednisone (blood)
• Pregnancy
• Statistics, Nonparametric
• Umbilical Cord (chemistry)