Posted 12/3/2007 2:24 PM (GMT -6)
Low birth weight, preterm delivery, and fetal growth restriction can be caused by many different things, so it would be problematic to discuss generally the long-term follow-up studies on low birth weight. Fetal exposure to elevated levels of cortisol and prednisone has been associated with long-term consequences for some, but not others, and the consequences likely depend on whether the fetus also has certain genes that make the brain vulnerable to the effects of prednisone (although this hasn't really been tested directly yet, so you couldn't go and get genetic testing). In some ways, this area of research is in its infancy and does not have sufficient follow-up, but the main findings suggest that if the child has problems, then it is most likely in the areas of memory, attention, and reactivity (highly reactive). But, the brain is very plastic, so even if a baby has been exposed to something that increases their chances of having a mild memory problems, you can essentially "work out" your brain and improve the areas that have been preturbed. Regarding breast feeding, that's a difficult question, because there are clearly many, many benefits of breast feeding. When a baby is born, he/she has practically no T cells and receives many of their immune cells via breast milk. In addiiton, breast feeding seems to be important for maternal-infant attachment. The majority of the studies I've seen tend to suggest that breast feeding is safe on low doses of prednisone. One study found some evidence that infant exposure to high levels of cortisol in breast milk increases their likelihood of have an anxious temperament and that women with comparable levels of cortisol in breast milk who did not breast feed did not have infants with an anxious temperament. I personally think that this research is difficult to interpret, because anxious mothers have high levels of cortisol, so it may be a learned response. Moreover, there may be something qualitatively different about women who decide to formula feed (I don't know that this is true, but it's something that wasn't tested in the study). Also, temperament was measured by a questionaire given to the mothers, so we were really getting a pretty biased view of the infant's temperament, in my opinion. Overall, I think the research to date is not great, but it seems like breast feeding is safe on prednisone (ask your doctor, as well) and there are many benefits that out weigh any potential problems.