ESPE Yearbook of Paediatric Endocrinology

J Clin Endocrinol Metab. 2020;105(7): e2439-48.https://pubmed.ncbi.nlm.nih.gov/32433752/

Here, the authors investigated the effects of dexamethasone (DEX) on metabolism in individuals without CAH but treated with DEX during the first trimester of fetal life. Prenatal DEX exposure was associated with decreased beta-cell function and higher cholesterol concentrations.

Prenatal treatment with DEX successfully ameliorates the virilization of the female fetus with CAH. However, the long-term outcomes on metabolic, somatic and cognitive health are of concern, given that many fetuses (all treated males, and females without CAH) are unnecessarily exposed. This observational study included 40 prenatal DEX-exposed participants and 75 population controls. Fasting blood samples were sampled from all participants and the following parameters were analysed: blood count, renal function, glucose homeostasis, and serum lipid profiles.

Prenatal DEX-exposed adults showed lower HOMA-β index (insulin secretion) and higher blood glucose concentrations, especially in younger participants and girls. Only one other study (1) has investigated glucose metabolism in prenatal DEX-exposed individuals. That study also found an association with decreased insulin secretion. Therefore, the current findings strengthen the evidence for a possible adverse effect on beta cell function. Furthermore, in the current study, older participants had significantly higher concentrations of total cholesterol and LDL cholesterol. This new evidence adds to other existing concerns regarding the long-term safety of prenatal DEX treatment in pregnancies at risk of CAH.

Reference: 1. Riveline JP, Baz B, Nguewa JL, Vidal-Trecan T, Ibrahim F, Boudou P, Vicaut E, Brac de la Perrière A, Fetita S, Bréant B, Blondeau B, Tardy-Guidollet V, Morel Y, Gautier JF. Exposure to Glucocorticoids in the First Part of Fetal Life is Associated with Insulin Secretory Defect in Adult Humans. J Clin Endocrinol Metab. 2020 105(3): dgz145.