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

  title={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},
  author={M Merc{\`e} Fern{\'a}ndez-Balsells and Kalpana Muthusamy and Galina Smushkin and Julianna F. Lampropulos and Mohamed B. Elamin and Nisrin O. Abu Elnour and Khalid B. Elamin and Neera Agrwal and Juan Fernando Gallegos-Orozco and Melanie A. Lane and Patricia J. Erwin and Victor M. Montori and M. Hassan Murad},
  journal={Clinical Endocrinology},
Context  Prenatal treatment with dexamethasone to prevent virilization in pregnancies at risk for classical congenital adrenal hyperplasia (CAH) remains controversial. 
Efficacy and safety of prenatal dexamethasone treatment in offspring at risk for congenital adrenal hyperplasia due to 21‐hydroxylase deficiency: A systematic review and meta‐analysis
To assess the efficacy and safety of prenatal dexamethasone treatment in offspring at risk for congenital adrenal hyperplasia, a large number of cases have been reported to have benefited from treatment with this drug.
Challenges in Prenatal Treatment with Dexamethasone.
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 are reviewed.
Preventing female virilisation in congenital adrenal hyperplasia: The controversial role of antenatal dexamethasone
Current controversies, potential improvements and future directions in the management of pregnancies at risk of CAH are summarized, including early prenatal diagnosis utilising noninvasive genetic techniques to minimise unnecessary dexamethasone exposure to unaffected fetuses.
Pregnancy in women with nonclassic congenital adrenal hyperplasia: Time to conceive and outcome
The objective of this study was to evaluate the effect of glucocorticoid treatment on fertility and on pregnancy outcome in women with NCAH.
The importance and implications of preconception genetic testing for accurate fetal risk estimation in 21-hydroxylase congenital adrenal hyperplasia (CAH)
  • Suresh Rama ChandranL. Loh
  • Medicine
    Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology
  • 2019
How the preconception genetic testing of a lady and her partner dramatically changed the estimated risk to their offspring and the major implications the results had on pregnancy planning are reported.
Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline.
Objective To update the congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency clinical practice guideline published by the Endocrine Society in 2010. Conclusions The writing
Congenital adrenal hyperplasia in pregnancy: approach depends on who is the ‘patient’
Prenatal treatment for CAH and prenatal therapy for prevention of virilization of possibly affected female children, dexamethasone is used, however, questions remain about the efficacy and safety of exposing 7/8 unaffected children in the first trimester.


Recent advances in the diagnosis and management of congenital adrenal hyperplasia due to 21-hydroxylase deficiency.
  • M. Forest
  • Biology, Medicine
    Human reproduction update
  • 2004
Prenatal diagnosis by direct mutation detection in previously genotyped families permits prenatal treatment of affected females in order to avoid or minimize genital virilization, and the state of heterozygotism can be predicted by hormonal testing and confirmed by molecular studies.
Prenatal treatment and diagnosis of congenital adrenal hyperplasia owing to steroid 21-hydroxylase deficiency.
Proper prenatal diagnosis and treatment of 21-OHD is effective in significantly reducing or eliminating virilization in the affected female, which spares the newborn female the consequences of genital ambiguity, i.e. genital surgery, sex misassignment, and gender confusion.
Gender and sexuality in classic congenital adrenal hyperplasia.
What causes low rates of child-bearing in congenital adrenal hyperplasia?
  • H. Meyer-Bahlburg
  • Medicine, Biology
    The Journal of clinical endocrinology and metabolism
  • 1999
The purpose of the present paper is to revisit the issue, review the status of the empirical evidence, especially the role of behavioral determinants, and suggest additional hormone-related psychological factors that may contribute to the low fertility rates of CAH women.
Cognitive functions in children at risk for congenital adrenal hyperplasia treated prenatally with dexamethasone.
Prenatally treated, CAH-affected children performed poorer than controls on tests measuring verbal processing speed, although this difference disappeared when controlling for the child's full-scale IQ.
Newborn screening for congenital adrenal hyperplasia.
  • B. Therrell
  • Medicine
    Endocrinology and metabolism clinics of North America
  • 2001
Prenatal glucocorticoids and long-term programming.
  • J. Seckl
  • Biology, Medicine
    European journal of endocrinology
  • 2004
The data suggest that both pharmacological and physiological exposure prenatally to excess glucocorticoids or stress might represent a mechanism linking foetal growth with adult pathophysiology in adult life.
Cognitive and motor development of children with and without congenital adrenal hyperplasia after early-prenatal dexamethasone.
It was unable to document any adverse effects of early-prenatal DEX treatment in the doses recommended for the treatment of pregnancies at risk for CAH on motor and cognitive development.
A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system.
The components of the GRADE system were summarized and described, and the features of GRADE that help bring clarity and consistency to guideline documents, making them more helpful to practicing clinicians and their patients with endocrine disorders were discussed.