title: Fetal endocrine therapy for congenital adrenal hyperplasia should not be done.
abstract: Prenatal treatment of congenital adrenal hyperplasia by administering dexamethasone to a woman presumed to be carrying an at-risk fetus remains a controversial experimental treatment. Review of data from animal experimentation and human trials indicates that dexamethasone cannot be considered safe for the fetus. In animals, prenatal dexamethasone decreases birth weight, affects renal, pancreatic beta cell and brain development, increases anxiety and predisposes to adult hypertension and hyperglycemia. In human studies, prenatal dexamethasone is associated with orofacial clefts, decreased birth weight, poorer verbal working memory, and poorer self-perception of scholastic and social competence. Numerous medical societies have cautioned that prenatal treatment of adrenal hyperplasia with dexamethasone is not appropriate for routine clinical practice and should only be done in Institutional Review Board approved, prospective clinical research settings with written informed consent. The data indicate that this treatment is inconsistent with the classic medical ethical maxim to 'first do no harm'.
authors.affiliation: Department of Pediatrics and Center for Reproductive Sciences, University of California, San Francisco, San Francisco CA 94143-0556, USA. Electronic address: wlmlab@ucsf.edu.
authors.forename: Walter L
authors.initials: WL
authors.lastname: Miller
mesh_terms: D000312:Adrenal Hyperplasia, Congenital / Q000150:complications / Q000188:drug therapy*; D003072:Cognition Disorders / Q000139:chemically induced*; D003907:Dexamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy*; D046128:Fetal Therapies / Q000009:adverse effects* / Q000941:ethics; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D014770:Virilism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone
keywords: CAH; adrenal hyperplasia; brain; dexamethasone; genetic diagnosis; prenatal treatment