Pharmacokinetics of corticosteroids during pregnancy

Glucocorticoids constitute one of the most frequently prescribed medicines during pregnancy. Their use is the mainstay for a variety of maternal and fetal indications, both in acute and chronic settings. The pharmacokinetics of corticosteroids during pregnancy remains poorly understood. Significant pharmacologic alterations occur secondary to the profound changes in the renal, gastrointestinal, and cardiovascular systems during human gestation. Additional research on this topic is a significant priority to increase therapeutic benefit while minimizing side effects for both the mother and fetus when corticosteroids are prescribed during pregnancy. Certain obstetrical conditions such as preeclampsia and multiple gestations are associated with different volumes of distribution and clearance rates of medications, adding further complexity to the therapeutic use of glucocorticoids. This article reviews the available literature, including the most significant physiologic alterations of pregnancy and basic concepts of glucocorticoid pharmacology. Finally, theoretical assumptions about the potential pharmacokinetic changes of glucocorticoids in pregnancy and their application to clinical settings are discussed.