Oral Hydrocortisone and breastfeeding

[Tap]

I am 35 weeks pregnant and have been taking oral hydrocortisone (now at 40 mg/day- early pregnancy was 15 mg/day- pre-pregnancy I was on Prednisone) for treatment of congenital adrenal hyperplasia (I will require a stress dose during delivery- typically a triple dose).
I very much want to breastfeed immediately after delivery and then continuing on. Some time after delivery, I anticipate the dose will be stepped down to early/pre-pregnancy dose, but this will take time. Is it safe for the baby to be breastfed immediately after delivery while I am on hydrocortisone. Then after delivery from a breastfeeding perspective, is there a better alternative to which I should consider being switched (prednisone or dexamethasone, etc.)? Are there any areas for concern I should be aware of for the baby (linear bone growth, increased susceptibility to infection, etc.)
Thank you for your guidance, as I have received conflicting advice from my medical professionals.

[admin]

Tap:

The dose of prednisone or dexamethasone used typically to control adrenal hyperplasia is generally quite low, prednisone (2.5 mg /day) or dexamethasone (0.25 mg/day). Neither of these would cause a problem at all for a breastfed infant, as steroids are generally excluded from the milk compartment.

The only thing you have to "think" about would be linear growth rate in the infant. I really doubt these low doses would have any long-term effect on the infant.

Tom Hale Ph.D.