What is the major concern regarding starting steroids in a pregnancy with hyperemesis gravidarum?

The primary concern when considering the use of steroids in a pregnancy complicated by hyperemesis gravidarum relates to the potential for fetal oral clefts. Research has indicated an association between the maternal use of corticosteroids during the first trimester and an increased risk of congenital malformations, including oral clefts. This is particularly pertinent when assessing treatment options for severe nausea and vomiting in pregnancy, as it weighs the benefits of symptom relief against the potential teratogenic effects of steroid medication.

The relationship between steroids and the risk of oral clefts is significant enough that it factors heavily into the decision-making process for managing hyperemesis gravidarum. While other concerns related to steroids, such as those pertaining to maternal hypertension or fetal growth interference, do exist, the specific link to oral clefts is a more pressing aspect of early pregnancy management in this context. This highlights the importance of careful risk assessment and monitoring when prescribing medication during pregnancy.