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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.

Abstract

OBJECTIVE

To assess the efficacy and safety of prenatal dexamethasone treatment in offspring at risk for congenital adrenal hyperplasia.

METHODS

MEDLINE, EMBASE, the Cochrane Library, the clinicaltrials.gov website databases were systematically searched from inception through March 2019. WMD and SMD with 95%CIs were calculated using random or fixed effects models.

RESULTS

There was a significant reduction in virilization in the DEX-treated group (WMD: -2.39, 95%CI: -3.31,-1.47). No significant differences were found in newborn physical outcomes for birth weight (WMD: 0.09, 95%CI: -0.09, 0.27) and birth length (WMD = 0.27, 95%CI: -0.68, 1.21). Concerning cognitive functions, no significant differences in the domains of psychometric intelligence (SMD: 0.05, 95%CI: -0.74, 0.83), verbal memory (SMD: -0.17, 95%CI: -0.58, 0.23), visual memory (SMD: 0.10, 95%CI: -0.14, 0.34), learning (SMD: -0.02, 95%CI: -0.27, 0.22) and verbal processing (SMD: -0.38, 95%CI: -0.93, 0.17). Regarding behavioural problems, no significant differences in the domains of internalizing problems (SMD: 0.16, 95%CI: -0.49, 0.81), externalizing problems (SMD: 0.07, 95%CI: -0.30, 0.43) and total problems (SMD: 0.14, 95%CI: -0.23, 0.51). With respect to temperament, no significant differences in the domains of emotionality (SMD: 0.13, 95%CI: -0.79, 1.05), activity (SMD: 0.04, 95%CI: -0.32, 0.39), shyness (SMD: 0.25, 95%CI: -0.70, 1.20) and sociability (SMD: -0.23, 95%CI: -0.90, 0.44).

CONCLUSIONS

Prenatal DEX treatment reduced virilization with no significant differences in newborn physical outcomes, cognitive functions, behavioural problems and temperament. The results need to be interpreted cautiously due to the existence of limitations.

Authors+Show Affiliations

Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China. Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, China.Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China. Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, China.Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China. Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, China.Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China. Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, China.Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China. Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, China.Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China. Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, China.Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China. Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, China.Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China. Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, China.Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China. Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, China. Department of Scientific research, Fujian Academy of Medical Sciences, Fuzhou, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31715010

Citation

Xu, Lizhen, et al. "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." Clinical Endocrinology, 2019.
Xu L, Lin W, Cai L, et al. 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. Clin Endocrinol (Oxf). 2019.
Xu, L., Lin, W., Cai, L., Huang, H., Liang, J., Li, L., ... Chen, G. (2019). 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. Clinical Endocrinology, doi:10.1111/cen.14126.
Xu L, et al. 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. Clin Endocrinol (Oxf). 2019 Nov 12; PubMed PMID: 31715010.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Xu,Lizhen, AU - Lin,Wei, AU - Cai,Liangchun, AU - Huang,Huibin, AU - Liang,Jixing, AU - Li,Liantao, AU - Zong,Liyao, AU - Wang,Nengying, AU - Wen,Junping, AU - Chen,Gang, Y1 - 2019/11/12/ PY - 2019/07/31/received PY - 2019/10/10/revised PY - 2019/11/08/accepted PY - 2019/11/13/pubmed PY - 2019/11/13/medline PY - 2019/11/13/entrez KW - 21-hydroxylase deficiency KW - cognition KW - congenital adrenal hyperplasia KW - dexamethasone KW - problem behaviour KW - temperament KW - virilization JF - Clinical endocrinology JO - Clin. Endocrinol. (Oxf) N2 - OBJECTIVE: To assess the efficacy and safety of prenatal dexamethasone treatment in offspring at risk for congenital adrenal hyperplasia. METHODS: MEDLINE, EMBASE, the Cochrane Library, the clinicaltrials.gov website databases were systematically searched from inception through March 2019. WMD and SMD with 95%CIs were calculated using random or fixed effects models. RESULTS: There was a significant reduction in virilization in the DEX-treated group (WMD: -2.39, 95%CI: -3.31,-1.47). No significant differences were found in newborn physical outcomes for birth weight (WMD: 0.09, 95%CI: -0.09, 0.27) and birth length (WMD = 0.27, 95%CI: -0.68, 1.21). Concerning cognitive functions, no significant differences in the domains of psychometric intelligence (SMD: 0.05, 95%CI: -0.74, 0.83), verbal memory (SMD: -0.17, 95%CI: -0.58, 0.23), visual memory (SMD: 0.10, 95%CI: -0.14, 0.34), learning (SMD: -0.02, 95%CI: -0.27, 0.22) and verbal processing (SMD: -0.38, 95%CI: -0.93, 0.17). Regarding behavioural problems, no significant differences in the domains of internalizing problems (SMD: 0.16, 95%CI: -0.49, 0.81), externalizing problems (SMD: 0.07, 95%CI: -0.30, 0.43) and total problems (SMD: 0.14, 95%CI: -0.23, 0.51). With respect to temperament, no significant differences in the domains of emotionality (SMD: 0.13, 95%CI: -0.79, 1.05), activity (SMD: 0.04, 95%CI: -0.32, 0.39), shyness (SMD: 0.25, 95%CI: -0.70, 1.20) and sociability (SMD: -0.23, 95%CI: -0.90, 0.44). CONCLUSIONS: Prenatal DEX treatment reduced virilization with no significant differences in newborn physical outcomes, cognitive functions, behavioural problems and temperament. The results need to be interpreted cautiously due to the existence of limitations. SN - 1365-2265 UR - https://www.unboundmedicine.com/medline/citation/31715010/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 L2 - https://doi.org/10.1111/cen.14126 DB - PRIME DP - Unbound Medicine ER -