Prenatal dexamethasone use for the prevention of virilization in pregnancies at risk for classical congenital adrenal hyperplasia because of 21-hydroxylase (CYP21A2) deficiency: a systematic review and meta-analyses

Summary Context  Prenatal treatment with dexamethasone to prevent virilization in pregnancies at risk for classical congenital adrenal hyperplasia (CAH) remains controversial. Objective  To conduct a systematic review and meta‐analyses of studies that evaluated the effects of dexamethasone administr...

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Published in:Clinical endocrinology (Oxford) 2010-10, Vol.73 (4), p.436-444
Main Authors: Mercè Fernández-Balsells, M., Muthusamy, Kalpana, Smushkin, Galina, Lampropulos, Julianna F., Elamin, Mohamed B., Abu Elnour, Nisrin O., Elamin, Khalid B., Agrwal, Neera, Gallegos-Orozco, Juan F., Lane, Melanie A., Erwin, Patricia J., Montori, Victor M., Murad, M. Hassan
Format: Article
Language:English
Subjects:
Adrenal Hyperplasia, Congenital - chemically induced
Adrenals. Adrenal axis. Renin-angiotensin system (diseases)
Biological and medical sciences
Dexamethasone - adverse effects
Endocrinopathies
Female
Fetus - drug effects
Fundamental and applied biological sciences. Psychology
Humans
Medical sciences
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Pregnancy
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk
Vertebrates: endocrinology
Virilism - prevention & control
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Summary:Summary Context  Prenatal treatment with dexamethasone to prevent virilization in pregnancies at risk for classical congenital adrenal hyperplasia (CAH) remains controversial. Objective  To conduct a systematic review and meta‐analyses of studies that evaluated the effects of dexamethasone administration during pregnancies at risk for classical CAH because of 21‐hydroxylase deficiency (CYP21A2). Data Sources  We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception through August 2009. Review of reference lists and contact with CAH experts further identified candidate studies. Study Selection  Reviewers working independently and in duplicate determined trial eligibility. Eligible studies reported the effects on either foetal or maternal outcomes of dexamethasone administered during pregnancy compared to a control group that did not receive any treatment. Data Extraction  Reviewers working independently and in duplicate determined the methodological quality of studies and collected data on patient characteristics, interventions, and outcomes. Data Synthesis  We identified only four eligible observational studies (325 pregnancies treated with dexamethasone). The methodological quality of the included studies was overall low. Meta‐analysis demonstrates a reduction in foetus virilization measured by Prader score in female foetuses treated with dexamethasone initiated early during pregnancy (weighted mean difference, −2·33, 95% CI, −3·38, −1·27). No deleterious effects of dexamethasone on stillbirths, spontaneous abortions, foetal malformations, neuropsychological or developmental outcomes were found although these data are quite sparse. There was increased oedema and striae in the mothers treated with dexamethasone. There were no data on long‐term follow‐up of physical and metabolic outcomes in children exposed to dexamethasone. Conclusions  The observational nature of the available evidence and the overall small sample size of the whole body of the literature significantly weaken inferences about the benefits and harms of dexamethasone in this setting. Dexamethasone seems to be associated with reduction in foetus virilization without significant maternal or foetal adverse effects. However, this review underscores the current uncertainty and further investigation is clearly needed. The decision about initiating treatment should be based on patients’ values and preferences and requires fully informed and consenting parents.
ISSN:0300-0664
1365-2265
DOI:10.1111/j.1365-2265.2010.03826.x