Prenatal dexamethasone use may affect virilization

In neonates at risk of congenital adrenal hyperplasia, prenatal dexamethasone (DEX) exposure appears to reduce virilization but exerts no effect on physical outcomes, cognitive functions, behavioural problems and temperament, according to the results of a meta-analysis.

Researchers searched multiple online databases for studies of prenatal DEX treatment that met the following criteria: population involved pregnant women and their offspring; cohort or case-control design; outcomes included virilization, newborn physical outcomes and other long-term effects.

Pooled data revealed a significant reduction in virilization in the DEX‐treated group (weighted mean difference [WMD], −2.39, 95 percent confidence interval [CI], −3.31 to –1.47). On the other hand, there were no significant differences observed in newborn physical outcomes for birth weight (WMD, 0.09, 95 percent CI, −0.09 to 0.27) and birth length (WMD, 0.27, 95 percent CI, −0.68 to 1.21).

Likewise, prenatal DEX treatment had no effect on cognitive functions, particularly in the domains of psychometric intelligence (standardized mean difference [SMD], 0.05, 95 percent CI, −0.74 to 0.83), verbal memory (SMD, −0.17, 95 percent CI, −0.58 to 0.23), visual memory (SMD, 0.10, 95 percent CI, −0.14 to 0.34), learning (SMD, −0.02, 95 percent CI, −0.27 to 0.22) and verbal processing (SMD, −0.38, 95 percent CI, −0.93 to 0.17).

Finally, behavioural problems and temperament were similar in the DEX-treated and untreated patients. There were no significant differences in the domains of internalizing problems (SMD, 0.16, 95 percent CI, −0.49 to 0.81), externalizing problems (SMD, 0.07, 95 percent CI, −0.30 to 0.43) and total problems (SMD, 0.14, 95 percent CI, −0.23, 0.51), as well as in the domains of emotionality (SMD, 0.13, 95 percent CI, −0.79 to 1.05), activity (SMD, 0.04, 95 percent CI, −0.32 to 0.39), shyness (SMD, 0.25, 95 percent CI, −0.70 to 1.20) and sociability (SMD, −0.23, 95 percent CI, −0.90 to 0.44).

The researchers, however, advised careful interpretation of the results due to the presence of limitations. They pointed out that prenatal treatment should be optimized through a multidisciplinary national strategy.