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Review
. 2018 Sep;16(1):186-193.
doi: 10.17458/per.vol16.2018.mcpa.dexamethasone.

Challenges in Prenatal Treatment with Dexamethasone

Bonnie McCann-Crosby  1 , Frank Xavier Placencia  2 , Oluyemisi Adeyemi-Fowode  3 , Jennifer Dietrich  3 , Rachel Franciskovich  4 , Sheila Gunn  5 , Marni Axelrad  6 , Duong Tu  7 , David Mann  8 , Lefkothea Karaviti, Vernon Reid Sutton
Affiliations
Review

Challenges in Prenatal Treatment with Dexamethasone

Bonnie McCann-Crosby et al. Pediatr Endocrinol Rev. 2018 Sep.

Abstract

Classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency causes elevated androgen levels, which can lead to virilization of female external genitalia. Prenatal dexamethasone treatment has been shown to be effective in preventing virilization of external genitalia when started prior to 7-9 weeks of gestation in females with classic CAH. However, CAH cannot be diagnosed prenatally until the end of the first trimester. Treating pregnant women with a fetus at risk of developing classic CAH exposes a significant proportion of fetuses unnecessarily, because only 1 in 8 would benefit from treatment. Consequently, prenatal dexamethasone treatment has been met with much controversy due to the potential adverse outcomes when exposed to high-dose steroids in utero. Here, we review the short- and long-term outcomes for fetuses and pregnant women exposed to dexamethasone treatment, the ethical considerations that must be taken into account, and current practice recommendations.

Keywords: Congenital Adrenal Hyperplasia; Ethics; Prenatal; Treatment.

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Figures

Figure 1.
Figure 1.
Adrenal Biosynthesis Defect in 21 hydroxylase Deficiency
Figure 2.
Figure 2.
Process of female sexual differentiation
Figure 3.
Figure 3.
Algorithm for Decisions Pertaining to the Prenatal Diagnosis and Treatment of 21-Hydroxylase Deficiency
See this image and copyright information in PMC

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