Efficacy and safety of prenatal dexamethasone treatment in offspring at risk for congenital adrenal hyperplasia due to 21-hydroxylase deficiency: A systematic review and meta-analysis.

Abstract

OBJECTIVE:

To assess the efficacy and safety of prenatal dexamethasone treatment in offspring at risk for congenital adrenal hyperplasia.

METHODS:

MEDLINE, EMBASE, the Cochrane Library, the clinicaltrials.gov website databases were systematically searched from inception through March 2019. WMD and SMD with 95%CIs were calculated using random or fixed effects models.

RESULTS:

There was a significant reduction in virilization in the DEX-treated group (WMD: -2.39, 95%CI: -3.31,-1.47). No significant differences were found in newborn physical outcomes for birth weight (WMD: 0.09, 95%CI: -0.09, 0.27) and birth length (WMD = 0.27, 95%CI: -0.68, 1.21). Concerning cognitive functions, no significant differences in the domains of psychometric intelligence (SMD: 0.05, 95%CI: -0.74, 0.83), verbal memory (SMD: -0.17, 95%CI: -0.58, 0.23), visual memory (SMD: 0.10, 95%CI: -0.14, 0.34), learning (SMD: -0.02, 95%CI: -0.27, 0.22) and verbal processing (SMD: -0.38, 95%CI: -0.93, 0.17). Regarding behavioural problems, no significant differences in the domains of internalizing problems (SMD: 0.16, 95%CI: -0.49, 0.81), externalizing problems (SMD: 0.07, 95%CI: -0.30, 0.43) and total problems (SMD: 0.14, 95%CI: -0.23, 0.51). With respect to temperament, no significant differences in the domains of emotionality (SMD: 0.13, 95%CI: -0.79, 1.05), activity (SMD: 0.04, 95%CI: -0.32, 0.39), shyness (SMD: 0.25, 95%CI: -0.70, 1.20) and sociability (SMD: -0.23, 95%CI: -0.90, 0.44).

CONCLUSIONS:

Prenatal DEX treatment reduced virilization with no significant differences in newborn physical outcomes, cognitive functions, behavioural problems and temperament. The results need to be interpreted cautiously due to the existence of limitations.

• Authors: Lizhen Xu, Wei Lin, Liangchun Cai, Huibin Huang, Jixing Liang, Liantao Li, Liyao Zong, Nengying Wang, Junping Wen, Gang Chen
• Journal: Clinical endocrinology (Clin Endocrinol (Oxf)) Vol. 92 Issue 2 Pg. 109-123 (02 2020) ISSN: 1365-2265 [Electronic] England
• PMID: 31715010 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2019 John Wiley & Sons Ltd.

Chemical References

• Dexamethasone

Topics

• Adrenal Hyperplasia, Congenital (drug therapy, genetics)
• Adult
• Cognition (drug effects)
• Dexamethasone (therapeutic use)
• Female
• Genetic Predisposition to Disease
• Humans
• Infant, Newborn
• Infant, Newborn, Diseases (drug therapy, prevention & control)
• Male
• Memory (drug effects)
• Pregnancy
• Prenatal Exposure Delayed Effects (chemically induced, genetics, psychology)
• Problem Behavior
• Risk Factors
• Treatment Outcome
• Virilism (chemically induced, drug therapy, genetics)