Prenatal Dexamethasone Treatment of Children at Risk for Congenital Adrenal Hyperplasia: The Swedish Experience and Standpoint

摘要

Prenatal DEX treatment of fetuses at risk for CAH is controversial. Results from animal studies, as well as stud- ies on prenatal glucocorticoid therapy in other contexts, have raised concerns regarding possible negative effects on behavioral and somatic development (2, 3). Adult corti- costeroid-exposed rodent offspring are characterized by hypertension (via reduced nephron number); hyperinsu- linemia and hyperglycemia (via permanently increased levels of the hepatic enzyme phosphoenolpyruvate car- boxylase); fatty liver but not obesity when given a high-fat diet; and hyperactivity of the hypothalamic-pituitary- adrenal axis and altered affective behavior, reminiscent of anxiety, as well as impaired learning and memory func- tions.