Maternal side effects of prenatal dexamethasone therapy for fetal congenital adrenal hyperplasia.
Prenatal treatment of virilizing congenital adrenal hyperplasia in female fetuses via maternal dexamethasone (Dex) therapy (1-1.5 mg/day) from first trimester to birth was associated with excessive weight gain (47-56 pounds at 35-37 weeks gestation), Cushingoid facial features, severe striae resulting in permanent scarring, and hyperglycemic response (8-11.7 nmol/L) to oral glucose administration in all our experience (three cases). Other symptoms included hypertension, gastrointestinal intolerance, or extreme irritability. Previous pregnancies were uncomplicated by these problems. In each case, first or second trimester amniotic fluid 17-hydroxyprogesterone (17OHP, 17-41 nmol/L; normal less than 0.4 nmol/L), androstenedione (22-31 nmol/L, normal less than 5 nmol/L), and testosterone levels (0.54-0.7 nmol/L, normal less than 0.4 nmol/L) during Dex treatment were elevated regardless of the newborn genital outcome. Maternal serum estriol (E3) levels in one mother (normal newborn genitalia) were consistently low (less than 0.2 nmol/L) during the second and third trimester. In two mothers (partially virilized newborn genitalia) initial second trimester E3 levels were unsuppressed (11, 17.4 nmol/L) and suppressed (less than 1.4 nmol/L) following short-term increased dose.


CONCLUSIONS
prenatal Dex treatment of virilizing congenital adrenal hyperplasia at a dose of 1-1.5 mg daily throughout gestation is associated with significant maternal side effects. Parents should be informed of these side effects before initiation of treatment. Careful monitoring for signs of side effects, medical intervention when necessary, and lowering of Dex dose during the second half of gestation would minimize the side effects. Maternal serum E3 levels appear useful for prediction of fetal outcome while amniotic fluid steroid levels may not.
Pang
S
S
Department of Pediatrics, University of Illinois College of Medicine, Chicago 60612.
Clark
A T
AT
Freeman
L C
LC
Dolan
L M
LM
Immken
L
L
Mueller
O T
OT
Stiff
D
D
Shulman
D I
DI
D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy*; D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry; D003480:Cushing Syndrome / Q000139:chemically induced; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D004958:Estradiol / Q000032:analysis / Q000097:blood; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy / Q000517:prevention & control*; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011248:Pregnancy Complications; D013739:Testosterone / Q000032:analysis / Q000097:blood; D014770:Virilism / Q000209:etiology; D015430:Weight Gain / Q000187:drug effects
D013739:Testosterone; D004958:Estradiol; D003907:Dexamethasone