title: 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.affiliation: 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
authors.forename: P J
authors.initials: PJ
authors.lastname: van Runnard Heimel
authors.forename: A F A M
authors.initials: AF
authors.lastname: Schobben
authors.forename: A J M
authors.initials: AJ
authors.lastname: Huisjes
authors.forename: A
authors.initials: A
authors.lastname: Franx
authors.forename: H W
authors.initials: HW
authors.lastname: Bruinse
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone; D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2; D011241:Prednisone