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Long-term Follow-up of Prenatally Treated Children at Risk for Congenital Adrenal Hyperplasia: Does Dexamethasone Cause Behavioural Problems?

T Hirvikoski, Molecular medicine and surgery, Karolinska Institutet, Stockholm, Sweden
A Nordenstrom, Molecular medicine and surgery, Karolinska Institutet, Stockholm, Sweden
T Lindholm, Psychology, Stockholm University, Stockholm, Sweden
F Lindblad, Institute of Stress Research, Stockholm University, Stockholm, Sweden
M Ritzen, Molecular medicine and surgery, Karolinska Institutet, Stockholm, Sweden
S Lajic, Molecular medicine and surgery, Karolinska Institutet, Stockholm, 17176, Sweden

Correspondence: Svetlana Lajic, Email: Svetlana.Lajic{at}ki.se

Abstract

Objectives: To investigate the long-term effects of prenatal treatment of congenital adrenal hyperplasia (CAH) with emphasis on behavioural problems and temperament.

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

Methods: Standardized 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 childrens self-ratings was investigated.

Results: There were no statistically significant differences between DEX-exposed children and controls on 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=.042). The correlation analysis showed only modest parent-child agreement on social anxiety, i.e. the increased social anxiety in childrens 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 the parents are thoroughly informed about the benefits and potential risks and uncertainties of this controversial treatment.