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Confirmed pregnancy. wants to take prednisone. CBC with high eosinophils. Miscarriage risks and precautions against it ?

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I have an important issue so I am hoping someone well-versed in reproductive endocrinology can assist.
I recently confirmed pregnancy. My cbc came back with Eosinophils at 7. My dr. Said they treat anything at a "2" and over with Prednisone. They said left untreated that it causes a risk of early miscarriage.
My last cbc in April showed Eos at 1.5. I have an autoimmune blood disorder called APS and am asymtomatic except for during pregnancy where I must be treated with Lovenox. This is my first pregnancy on the drug.

To get pregnant this time, I used 3 days worth of generic Menapur (HMG). I developed welts that hurt and then itched as they healed. The last shot was 19 days ago.
I am wondering if the allergic reaction I had to the HMG shots would have caused the elevation in Eosinophils.
I am NOT AT ALL comfortable taking steroids during pregnancy. I fear that if this level should get elevated again that they will recommend that I go off and on Prednisone. I want a natural alternative OR to simply be at peace that the EOS will not effect my pregnancy since many women have allergies, hay fever etc while pregnant and I am not aware that they are all put on steroids if their EOS are higher. Or if this is even checked.
I will not throw drugs at everything if it isn't emergent.
Please give me your opinion on this dilemma. Is there a risk that my body will reject the embryo if I don't lower the Eosinophils in my blood??
Thanks for the advice. This is very important.
Posted Wed, 2 May 2012 in Pregnancy
Answered by Dr. Chetna Jain 43 hours later

Thanks for posting the query.

First of all hearty congratulations for the good news.
Its important to continue Lovenox as you had a pregnancy loss at 23 weeks.

your high eosinophil count is significant. I suggest a repeat count to see if the levels are dropping fast then they will settle and there is not much risk.
If the counts are still high then its advisable to take prednisolone till they settle and then a gradual withdrawl.Prednisolone is considered safe in pregnancy and is unlikely to cause fetal malformations.

Its also important to take low dose Aspirin along with low dose heparin for better pregnancy outcome. You should check for development of high BP, growth restriction and blood flow to the uterus (doppler ultrasound). Your Obstetrician will guide you on that.

Since you are allergic to many things, keep watch on abnormal rashes or other side effects when you are taking these medications.

I hope, I have answered your query. I will be available for follow up queries if any.

Above answer was peer-reviewed by
Follow-up: Confirmed pregnancy. wants to take prednisone. CBC with high eosinophils. Miscarriage risks and precautions against it ? 4 hours later
Thank you for the reponse, Dr. XXXXXXX
Specifically, does the higher Eosinophils put me at risk for a miscarriage?
What are the alternatives to Prednisone?
I understand that it is "unlikely" to cause fetal malformations, however studies have shown an increased risk of birth defects and I am not comfortable taking a steroid during pregnancy.
It is my understanding that higher Eosinophils are present in allergies. If this is the case, why arent all pregnant women with allergies treated with Prednisone?
What damage will higher Eosinophils pose to my pregnancy? Again, miscarriage? Other issues?
If higher Eos are not an emergent situation, I want to be clearer on this subject.
I am not a person who wants unecessary drugs in my body during pregnancy.
I am doing Lovenox and baby aspirin, and I do that only because it IS in fact emergent.
I will be transferring from my RE to a Perinatologist in a few weeks to me monitored.
Thanks in advance for clarifying. I would absolutely like clarification on those items I wrote today above.
thank you!
Answered by Dr. Chetna Jain 15 hours later
Thanks for the follow up.

The chances of pregnancy loss(miscarriage) due to eosinophilia is very low.

In medicine a condition is treated if the benefits outweigh risks. Hence in your case it is safer to be on steroid than without.

A variety of steroids are available for clinical use. Each one has different use, e.g.dexamethasone or betamethasone are used for fetal lung maturity.In allergies prednisolone has good results.

It has been widely used ,hence a long safety track record is there. Eminent professional bodies like(RCOG-Royal college of OBG) considers it safe for use in pregnancy.

High eosinophil counts like any other allergic reaction can increase the chances of miscarriage and preterm labor.

A lot of pregnant women do receive prednisolone during pregnancy. Not everybody needs treatment. It is determined based on the history and the clinical condition.

Your treating doctor would not like to take a chance in view of your history(miscarriage ffd by conception through fertility management).

Please do a repeat eosinophil count. Falling levels will save you from prednisolone.

Wishing you good health.

Dr Chetna Jain
Above answer was peer-reviewed by
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