Long-term follow-up of prenatally treated children at risk for congenital adrenal hyperplasia: does dexamethasone cause behavioural problems?
OBJECTIVE
To investigate the long-term effects of prenatal treatment of congenital adrenal hyperplasia (CAH) with emphasis on behavioural problems and temperament.


METHODS
A population-based long-term follow-up study of Swedish children at risk for virilising CAH, who had received treatment prenatally with dexamethasone (DEX). The questionnaire-based follow-up was performed when the children had reached school age.


METHODS
Standardised parent-completed questionnaires were used to evaluate adaptive functioning, behavioural/emotional problems and psychopathology, social anxiety and temperament in DEX-exposed school-aged children (n=26) and matched controls (n=35). In addition, the association between parental questionnaires and children's self-ratings was investigated.


RESULTS
There were no statistically significant differences between DEX-exposed children and controls in measures of psychopathology, behavioural problems and adaptive functioning. In a questionnaire on temperamental traits, DEX-exposed children were described by their parents as being more sociable than controls (P=0.042). The correlation analysis showed only modest parent-child agreement on social anxiety, i.e. the increased social anxiety in children's self-ratings was not confirmed by their parents.


CONCLUSIONS
DEX-treated children showed good overall adjustment. The parent-child agreement with respect to social anxiety was modest, highlighting the importance of multiple information sources and assessment methods. The clinical significance of the observed difference in sociability cannot be determined within the frameworks of this study. Additional studies of larger cohorts are essential to make more decisive conclusions on the safety of the treatment. Until then, it is important that parents are thoroughly informed about the benefits and potential risks and uncertainties of this controversial treatment.
Hirvikoski
Tatja
T
Departments of Psychiatry Molecular Medicine and Surgery Clintec Woman and Child Health, Karolinska Institutet, 171 76 Stockholm, Sweden.
Nordenström
Anna
A
Lindholm
Torun
T
Lindblad
Frank
F
Ritzén
E Martin
EM
Lajic
Svetlana
S
D000223:Adaptation, Psychological / Q000187:drug effects; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000196:embryology / Q000209:etiology / Q000517:prevention & control*; D001007:Anxiety / Q000139:chemically induced; D016022:Case-Control Studies; D002648:Child; D002653:Child Behavior Disorders / Q000139:chemically induced* / Q000453:epidemiology*; D003907:Dexamethasone / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D005315:Fetal Diseases / Q000209:etiology / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors; D012919:Social Behavior; D011795:Surveys and Questionnaires; D013694:Temperament / Q000187:drug effects; D013997:Time Factors
D003907:Dexamethasone