The transplacental passage of prednisolone in pregnancies complicated by early-onset HELLP syndrome.
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.
van Runnard Heimel
P J
PJ
Department of Perinatology and Gynaecology, University Medical Centre Utrecht, KJ.02.507.0/P.O. Box 85090, 3508 AB Utrecht, The Netherlands. heimel@hotmail.com
Schobben
A F A M
AF
Huisjes
A J M
AJ
Franx
A
A
Bruinse
H W
HW
D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2 / Q000378:metabolism; D000893:Anti-Inflammatory Agents / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D005260:Female; D005333:Fetus; D017359:HELLP Syndrome / Q000188:drug therapy / Q000378:metabolism*; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D011239:Prednisolone / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D011241:Prednisone / Q000097:blood; D011247:Pregnancy; D018709:Statistics, Nonparametric; D014470:Umbilical Cord / Q000737:chemistry
D000893:Anti-Inflammatory Agents; D011239:Prednisolone; D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2; D011241:Prednisone