*8.2.2 Glucocorticoids*

Glucocorticoids (GC) have a remarkable path in the treatment of autoimmune diseases, such as SLE. Yet, its chronic use is associated with multiple side-effects and organ damage [59]. Prednisone and prednisolone are glucocorticoids recommended during pregnancy due to its pharmacokinetics and its shorter duration of action, since they are metabolized by placental enzymes the fetus is basically unexposed. The recommended daily dose should be ≤7.5 mg of prednisone. Doses superior to 10 mg/day are associated with preterm delivery, premature rupture of membranes and FGR. Higher doses should be reserved for organ-threatening situations, when the benefits outweigh the risks [60]. For hypothalamic–pituitary–adrenal axis suppression, for example, we use doses superior to 5 mg/day for at least 3 weeks, after the first trimester, so that labor and delivery can be managed accordingly.

Methylprednisolone has similar rates of placental transfer to prednisone so it is expected to be safe and compatible with pregnancy [20].
