Prenatal dexamethasone treatment: long-term cognitive outcome in children
The prenatal therapy with dexamethasone in order to prevent virilization of the external genitalia and the effect of excess androgens on sexual differentiation of the brain in a ХХ-fetus deficient in 21-hydroxylase. Evaluation of its effectiveness.
| Рубрика | Медицина |
| Вид | статья |
| Язык | английский |
| Дата добавления | 19.04.2018 |
| Размер файла | 20,6 K |
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Prenatal dexamethasone treatment: long-term cognitive outcome in children
Objectives: to study possible long-term effects of prenatal glucocorticoid treatment on children cognition.
Design: the prospective research of intellectual development patterns of 288 children from mothers, prenatally treated with dexamethasone, and of 107 children (the observational group) from mothers, not treated with dexamethasone, with high biochemical markers of adrenal hyperadnrogenism.
Methods: from 2002 to 2011 the children of the treatment group (n=288) were examined at the age of 1 (n=144), at the age of 2 (n=58), at the age of 3 (n=26) and up to the primary school age (mean 7, 8 years, rang 7-9) - (n=90). The retrospective review of prenatal records showed that the average daily dose of prenatal dexamethasone was 2,44±1,17 м/kg of body mass and the duration of glucocorticoid treatment varied from 6 to 24 weeks (22,8±1,6 weeks). 57 infants of early childhood and 50 children of primary school age were included into the observational group. The early age children neuropsychic development was assessed via average development index assay (ИРср) for every psychoneurological function according the methods of I.A. Skvortsova, N.A. Ermolenko. The intellectual development patterns of primary school age children were investigated using a children form of WAIS test.
The present clinical research has been approved by Ethics Committee and conducted pursuant to the Declaration of Helsinki. All parents/guardians of the patients included into the research have signed patient informed consents.
Results: examining children of the similar groups at an earlier age (1-3 years old) has not revealed any differences of their intellectual development (р < 0,5). The level of general intelligence of children whose mothers have been treated with dexamethasone in I and II trimesters of pregnancy is considerably lower than that of children from the observational group. These children have been also characterized with the impairment of speech development (р = 0,005), verbal reasoning and logical thinking (p = 0,0003), maturity of volitional attention and ability of organizing and monitoring activities (р=0,01).
School Age Children's IQ Quotient of Treatment and Observational Groups (0 - Observational Group, 1 - DEX-treatment in I trimester, 2 - DEX-treatment in II trimester, 3 - DEX-treatment in III trimester)
prenatal dexamethasone androgen genitalia
No differences of cognitive development between children, prenatally treated with dexamethasone in III trimester, and the observational group have been observed.
Conclusions: prenatal DEX-treatment at an early gestation can result in significant adverse effects on intellectual abilities of children furtheron.
References
1. Kareva M.A.; Chugunov I.S. Federal clinical practice guidelines on the management of the patients presenting with congenital adrenal hyperplasia // Problemy Endokrinologii, v. 60, n2, p. 42-50, april 2014. ISSN 0375-9660 (Print) 2308-1430 (Electronic). doi: 14341/probl201460242-50.
2. Tardy-Guidollet V, Menassa R, et all. New management strategy of pregnancies at risk of congenital adrenal hyperplasia using fetal sex determination in maternal serum: French cohort of 258 cases (2002-2011) //. Epub. - 2014 Apr; 99 (4):1180-8. doi: 10.1210/jc.2013-2895
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