Prednisone during second trimester

Orsuc

4 Posts
Reply Posted on: Aug 17, 2014 at 9:18pm
Hi Dr Braverman,

I am 21 weeks pregnant and as my cytokines are elevated, I am being recommended Ivig. Since we can't afford Ivig another time (have been doing infusions every four weeks since positive pregnancy test), I am being recommended to go back on 10mg prednsione. Thing is, I have just weanned off my prednisone after 6 months on it, and have been off it for ten days now, so I was wondering if it would be safe to go back on it at this point on pregnancy? I keep reading you stop prednisone by 16 weeks but other RIs recommend it during second and even third trimester so I wonder how would you see this? How late would you recomend Ivig also? Thanks a lot!

Dr. Braverman

2026 Posts
RE: Prednisone during second trimester Posted on: Aug 18, 2014 at 6:32am
At 24 weeks of pregnancy the placenta loses its abilty to break down prednisione so most of it gets through to the baby so unless for a "short" course I prefer not to use it at this time. When you say cytokines are elevated are the intracellular ratios? IF so from what cell lines were the studied. Were there any serum cytokines measured? I think you need to answer these questions before you consider any prolgoned therapy as well as a look at other cell lines such as CD8 cells .
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Orsuc

4 Posts
Reply RE: Prednisone during second trimester Posted on: Aug 18, 2014 at 2:37pm
Thank you for your response Dr Braverman. Yes, we tested cytokines ratio, TNF:IL10 was 35.9 and IFN:IL10 was 18.9 so I was suggested Ivig. I am also uncomfortable by going back on prednsione, especially after being on it for 6 months and finally being off it for 10 days only and I get concerned with prednsione getting to the baby and causing harm. On the other hand, Ivig out of pocket is just way too expensive so not sure how will we proceed here. Thank you.

Dr. Braverman

2026 Posts
RE: Prednisone during second trimester Posted on: Aug 18, 2014 at 3:06pm
Based on the information you gave me alone there is not enough data to support continued IVIG or prednisone. Not sure why you were doing IVIG at all and cerainly not sure why you are being recommended to go back on prednisone with such limited information.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Orsuc

4 Posts
Reply RE: Prednisone during second trimester Posted on: Aug 19, 2014 at 2:56am
Thank you anyway Dr Braverman. It's really confusing because some RIs go by cytokine ratios and it's based on this ratio results that I have been recommended Ivig. I am just questioning it because financially it's becoming undoable and I also wonder if at this point at 22 weeks I still need to worry about Ivig. The prednisone is scaring me a bit though. Thanks a lot.

Dr. Braverman

2026 Posts
RE: Prednisone during second trimester Posted on: Aug 19, 2014 at 5:35am
They dont use these ratios by choice , they use them because that is all that the laboratories offer and the testing for RI in these labs has not been updated for over 10 years. Our lab is the only one in the world that looks at the entire immune system which is critical to make these kinds of decisions(see our diagnositic testing page) . As most do not need continued treatment I would guess(and that is all it is right now as I dont know your entire history) that you do not need further treatment. Certainly the limited testing that you have had can not be used to make such a significant treatment decision .
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.