Antenatal dexamethasone treatment and long-term programming

Introduction. Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) is one of the most common autosomal recessive disorders, affecting 1:9000-1:15000 live births. During the last twenty years in most countries prenatal DEXtreatment has been used to prevent genital virilisation and androgen excess outcome on sex brain differentiation of XX-foetus with 21-hydroxylase deficiency. Fetal DEX-treatment for the prevention of prenatal virilization of genitalia in girls affected by classic congenital adrenal hyperplasia (CAH) has been used in many medical centers worldwide since the mid-1980s. The treatment is effective in reducing virilization, but the potential long-term outcome has only been investigated in a minority of treated cases.Aim. To study possible long-term effects of prenatal glucocorticoid treatment on children cognition and physical development.Materials and methods. The prospective research of intellectual development patterns of 288 children from mothers prenatally treated with dexamethasone, and of 107 children (the observational group) from mothers, not treated with dexamethasone, with high biochemical markers of adrenal hyperandrogenism.Results. Significant differences of frequency of overweight and obesity (p = 0.04); of intellectual quotients (p = 0.0004) in schoolaged children have been revealed in the treatment group vs observational group. The level of general intelligence of school-aged children whose mothers have been treated with dexamethasone in I and II trimesters of pregnancy is considerably lower than that of children from the observational group (p = 0.004; p = 0.0005, respectively). The tendency of correlation between IQ quotients of school-aged children and the initiation date of prenatal dexamethasone treatment has been established (r = 0.27; p = 0.004).Сonclusion. Prenatal DEX-treatment at an early gestation can result in significant adverse effects on intellectual abilities and physical development of children furtheron.