Can I take hydrocortisone injections while pregnant or breastfeeding?

If pregnant or breast-feeding ask a health professional before use.

Drug Facts label: Marie Originals Medicated Outdoor Anti Itch (topical), Marie's Original Formulas, LLC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

Pregnancy: Teratogenic Effects Corticosteroids have been shown to be teratogenic in many species when given in doses equivalent to the human dose. Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring. There are no adequate and well-controlled studies in pregnant women. Corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Infants born to mothers who have received corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.

Prescribing label, section “Pregnancy”: Solu-Cortef (intramuscular, intravenous), Pharmacia & Upjohn Company LLC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

This quote is from the intramuscular/intravenous formulation label.

Hydrocortisone (cortisol) is a normal component of breastmilk, but it has not been studied in milk after exogenous administration in pharmacologic amounts. Although it is unlikely that dangerous amounts of hydrocortisone would reach the infant, a better studied corticosteroid might be preferred. Maternal use of hydrocortisone as an enema would not be expected to cause any adverse effects in breastfed infants. Local maternal injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants. Medium to large doses of corticosteroids given systemically or injected into joints or the breast have been reported to cause temporary reduction of lactation. See also Hydrocortisone, Topical.

Cortisol in breastmilk might have a role in intestinal maturation, the intestinal microbiome, growth, body composition or neurodevelopment, but adequate studies are lacking.[1] Concentrations follow a diurnal rhythm, with the highest concentrations in the morning at about 7:00 am and the lowest concentrations in the late afternoon and evening.[2,3] Cortisol concentration in milk increases with infant age and milk cortisol levels; it decreases with complementary feeding and infant illness.[4,5] Cortisol in milk may protect against later infant obesity, especially in girls;[6] however, in another study, milk glucocorticoid levels were positively associated with percent fat mass, adiposity and head circumference at 1 year of age.[7] Maternal stress can increase breastmilk cortisol levels, especially with preterm births.[8-11] Milk cortisol may mediate infant emotions and infant sleep, but not crying, is correlated with the levels of cortisone and cortisol in milk.[12,13] Some information indicates that maternal adverse childhood experiences may decrease cortisol concentration in their breastmilk.[14]

“Summary of Use during Lactation”, LactMed record “Hydrocortisone” (LM138), quoted verbatim. Everything LactMed reports about Hydrocortisone while breastfeeding.

Nursing Mothers: Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. Because of the potential for serious adverse reactions in nursing infants from corticosteroids, a decision should be made whether to continue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Prescribing label, section “Nursing Mothers”: Solu-Cortef (intramuscular, intravenous), Pharmacia & Upjohn Company LLC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

This quote is from the intramuscular/intravenous formulation label.