Prednisone Use in Pregnancy and Implantation

Safety and Efficacy

The European Respiratory Society suggests that controlled immune activation is necessary for endometrial receptivity, embryo tolerance, vascular adaptation for placental development, and establishing proper developmental trajectories 1
The American College of Rheumatology recommends that prednisone can be used safely in pregnant women with autoimmune disease or severe asthma, with doses tapered to ≤5 mg/day when possible 2, 3, 4
Higher doses of prednisone carry dose-related risks including gestational diabetes, preterm birth, and maternal infections 2, 3, 4
There is conflicting older data suggesting a possible increased risk of cleft lip/palate with first-trimester use of prednisone, though more recent studies have not confirmed this association 1, 5

The American College of Obstetricians and Gynecologists recommends that prednisone should not be prescribed to improve implantation in women attempting conception or undergoing IVF 1
For women with established autoimmune disease requiring prednisone, the lowest effective dose should be used, ideally ≤5 mg/day, and monitored for gestational diabetes, preterm labor, and maternal infections 2, 3, 4