ESPE Abstracts (2018) 89 P-P1-001

Evaluation of Long Term Metabolic Effects After Prenatal Dexamethasone Treatment in the Context of CAH - the Swedish Cohort

Lena Wallensteen, Leif Karlsson, Valeria Messina, Anna Nordenström & Svetlana Lajic

Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden

Background: Prenatal dexamethasone (DEX) treatment is in many countries offered to the pregnant woman, at risk of having a child with classic congenital adrenal hyperplasia (CAH), to reduce virilization in an affected female fetus. The treatment is effective in reducing virilization but may give long lasting effects on somatic and cognitive health. Here, we explore the potential effect on metabolism in children and adults not having CAH and exposed to DEX during the first trimester of fetal life.

Objective and hypotheses: We hypothesize that prenatal DEX treatment has negative effects on glucose and lipid metabolism.

Method: All treated subjects (n=40, age range 5.2–26.4) as well as control subjects (n=75, age range 4.5–25.9) gave blood samples after one night fast to assess blood count, renal function, glucose homeostasis and the incidence of dyslipidemia. The glomerular filtration rate was calculated using four different methods. Insulin resistance and beta-cell function was determined with HOMA-beta and HOMA-IR. For significant differences, we performed post hoc tests to further verify the results.

Results: There were no significant differences between the groups regarding age, weight, height, BMI or birth data. The results show no significant effects of prenatal DEX treatment on blood count, renal function, glucose homeostasis and dyslipidemia (all P>0.05). In the MANCOVA there was a significant DEXxSEX interaction for the parameter C-peptide (P=0.043), but the result did not remain significant after post-hoc analysis.

Conclusion: There is no major impact of first trimester DEX treatment on metabolism in childhood and in young adulthood. However, the long-term effects during late adulthood remain to be investigated. The eldest DEX treated individual in our cohort was, at time of testing, only 26 years old. Metabolic diseases usually present later in life which makes the need for longer follow-up necessary.

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