How safe is long-term prenatal glucocorticoid treatment?
Abstract
GLUCOCORTICOIDS are commonly used in obstetric practice, both for maternal immunosuppression and for shortterm treatment of the fetus, usually to accelerate lung maturation when there is threatened preterm delivery. The immediate benefits of short-term prepartum glucocorticoid therapy in maturing the fetal lung and reducing neonatal mortality are clearly supported by controlled studies.1,2Recently, long-term prenatal therapy of fetuses potentially affected with congenital adrenal hyperplasia (CAH) has been advocated,3,4but the safety of this experimental therapy has not been established in rigorously controlled trials. See also p 1073. Congenital adrenal hyperplasia is a recessively inherited disease in which a disordered steroidogenic enzyme, usually P450c21 (21-hydroxylase), diverts adrenal steroid synthesis away from cortisol toward androgens.5In utero, low fetal plasma cortisol levels stimulate increased corticotropin (ACTH) secretion, which in turn stimulates further adrenal steroidogenesis, resulting in even more androgen synthesis. In an XY male fetus, these adrenal androgens have
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Since the mid-1980s, prenatal treatment with high doses of dexamethasone has been proposed for pregnant women with a fetus at risk for classic CAH using a protocol of 20 μg/kg/day, maximum 1.5 mg/day, aiming to prevent prenatal virilization of the external genitalia in affected girls.
“Since the mid-1980's, prenatal treatment with high doses of Dex has been proposed for to pregnant women with a fetus at risk for classic CAH using a treatment protocol of 20 µg/kg/day, maximum 1.5 mg/day, with the aim of preventing prenatal virilization of the external genitalia in affected girls (313,317,440).”
From Congenital Adrenal Hyperplasia—Current Insights in Pathophysiology, Diagnostics, and Management (2022) · cites this paper as [440]
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- Authors
- Seckl, J. R.
- Affiliations
- Western General Hospital (GB)
- Corresponding author
- Seckl, Jonathan R.
- ORCID
- Seckl, Jonathan R.
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1997-04-02
- Volume
- 277
- Issue
- 13
- Pages
- 1077
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2087015880
- Cited by
- 118
- References
- 4
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 3 · 2016: 2 · 2015: 4 · 2014: 1 · 2013: 2 · 2012: 4
- FWCI
- 3.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01dk042154-09)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-37922, DK 42154, R01DK037922)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- antenatal glucocorticoids, congenital adrenal hyperplasia, 21-hydroxylase deficiency, long-term safety, fetal lung maturation, preterm birth, neonatal mortality, maternal immunosuppression, ACTH stimulation test
- MeSH terms
- Adrenal Hyperplasia, Congenital, Animals, Clinical Trials as Topic, Dexamethasone, Ethics, Medical, Female, Fetal Diseases, Glucocorticoids, Humans, Male, Pregnancy, Prenatal Exposure Delayed Effects, Rats
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