Cognitive function is reduced in healthy girls exposed to early prenatal dexamethasone, which suggests the therapy should not be used in fetuses at risk for congenital adrenal hyperplasia before genotype is known, according to researchers.
Svetlana Lajic, MD, PhD, of the department of Women’s and Children’s Health, pediatric endocrinology unit at Karolinska University in Sweden, and colleagues evaluated children and adolescents aged 7 to 17 years whose mothers were treated with dexamethasone while pregnant (n = 34; 16 girls) and untreated controls (n = 66; 36 girls) from Sweden to determine the long-term cognitive effects of prenatal dexamethasone therapy. Participants completed standardized neuropsychological tests and questionnaires.
Using the Wechsler Intelligence Scales for Children-III, researchers found significant interactions between dexamethasone and sex for nonverbal processing speed (P = .044), nonverbal intelligence (P = .013) and verbal intelligence (P = .025). The interaction between dexamethasone and sex for verbal working memory nearly reached significance (P = .074). Researchers observed a negative main effect of dexamethasone on verbal working memory (P = .005). Girls with early prenatal dexamethasone exposure scored lower than female controls on all tests (nonverbal processing speed, P = .068; nonverbal intelligence, P = .021; verbal intelligence, P = .014; and verbal working memory, P = .001).
No significant differences were found between boys with early prenatal dexamethasone and male controls.
“Our results suggest that early prenatal [dexamethasone] exposure, as employed in prenatal treatment of fetuses at risk for [congenital adrenal hyperplasia], is likely to affect cognitive functions in health girls, ie, children who do not benefit from the treatment,” the researchers wrote. “It can therefore not be considered safe to use this therapy in the context of [congenital adrenal hyperplasia] although extended studies in additional cohorts around the world are warranted. If [dexamethasone] is still offered, it is essential that information about the risks and benefits of the treatment is given to the pregnant couple. The treatment should be questioned and should only be offered within the framework of a clinical study with longitudinal long-term follow-ups of mothers and children. Given the importance of working memory for academic performance, screening for deficits should be performed and interventional strategies might be needed in [dexamethasone]-treated cases.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.