medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-035medsovet-8277Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYАнтенатальное применение глюкокортикоидов и программирование здоровья детейAntenatal dexamethasone treatment and long-term programminghttps://orcid.org/0000-0002-8632-3075ШайтароваА. В.ShaitarovaA. V.

Шайтарова Анна Владимировна, к.м.н., доцент, доцент кафедры педиатрии и неонатологии

625023, Тюмень, ул. Одесская, д. 54

Anna V. Shaitarova, Cand. Sci. (Med.), Associate Professor of the Department of Pediatrics and Neonatology

54, Odesskaya St., Тyumen, 625023

annashaytarova@mail.ruhttps://orcid.org/0000-0001-9253-8075СуплотоваЛ. А.SuplotovaL. A.

Суплотова Людмила Александровна, д.м.н., профессор, заведующая курсом эндокринологии кафедры терапии

625023, Тюмень, ул. Одесская, д. 54

Lyudmila A. Suplotova, Dr. Sci. (Med.), Рrofessor, Head of the Endocrinology course at the Department of Therapy

54, Odesskaya St., Тyumen, 625023

suplotovala@mail.ruТюменский государственный медицинский университетРоссияTyumen State Medical UniversityRussian Federation20241905202406132139Copyright © Шайтарова А.В., Суплотова Л.А., 20242024Шайтарова А.В., Суплотова Л.А.Shaitarova A.V., Suplotova L.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8277Введение

Введение. Врожденная дисфункция коры надпочечников (ВДКН), обусловленная дефицитом 21-гидроксилазы, является одним из наиболее распространенных аутосомно-рецессивных заболеваний, частота которого составляет от 1:9000 до 1:15000 живых новорожденных. С середины 1980-х годов во многих медицинских центрах мира применяется антенатальная терапия дексаметазоном с целью предотвращения вирилизации у XX-плодов с дефицитом 21-гидроксилазы. Лечение эффективно снижает вирилизацию, но его потенциальные долгосрочные побочные эффекты в значительной степени неизвестны.

Цель

Цель. Оценить долгосрочные эффекты антенатальной терапии дексаметазоном на физическое и интеллектуальное развития детей.

Материалы и методы

Материалы и методы. Проведено проспективное лонгитудинальное исследование особенностей физического, нервнопсихического и интеллектуального развития детей (n = 288) от матерей с адреналовой гиперандрогенией, которые принимали дексаметазон во время беременности с целью профилактики репродуктивных потерь, и детей (n = 107) от матерей с высокими биохимическими маркерами адреналовой гиперандрогении, которые дексаметазон не принимали.

Результаты

Результаты. По достижении школьного возраста у детей основной и контрольной групп выявлены значимые различия в частоте избытка массы тела и ожирения (p = 0,04) и показателей интеллекта (p = 0,0004). У школьников, матери которых принимали дексаметазон в I и II триместрах беременности, показатель IQ был значительно ниже, чем у детей контрольной группы (р = 0,004; р = 0,0005 соответственно). Установлена тенденция к взаимосвязи между показателями IQ детей в школьном возрасте и сроком начала терапии дексаметазоном у матери (r = 0,27; p = 0,004).

Выводы

Выводы. Применение дексаметазона у беременных женщин в ранние сроки гестации оказывает отсроченные негативные эффекты на физическое и интеллектуальное развитие детей.

Introduction

Introduction. Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) is one of the most common autosomal recessive disorders, affecting 1:9000-1:15000 live births. During the last twenty years in most countries prenatal DEXtreatment has been used to prevent genital virilisation and androgen excess outcome on sex brain differentiation of XX-foetus with 21-hydroxylase deficiency. Fetal DEX-treatment for the prevention of prenatal virilization of genitalia in girls affected by classic congenital adrenal hyperplasia (CAH) has been used in many medical centers worldwide since the mid-1980s. The treatment is effective in reducing virilization, but the potential long-term outcome has only been investigated in a minority of treated cases.

Aim

Aim. To study possible long-term effects of prenatal glucocorticoid treatment on children cognition and physical development.

Materials and methods

Materials and methods. The prospective research of intellectual development patterns of 288 children from mothers prenatally treated with dexamethasone, and of 107 children (the observational group) from mothers, not treated with dexamethasone, with high biochemical markers of adrenal hyperandrogenism.

Results

Results. Significant differences of frequency of overweight and obesity (p = 0.04); of intellectual quotients (p = 0.0004) in schoolaged children have been revealed in the treatment group vs observational group. The level of general intelligence of school-aged children whose mothers have been treated with dexamethasone in I and II trimesters of pregnancy is considerably lower than that of children from the observational group (p = 0.004; p = 0.0005, respectively). The tendency of correlation between IQ quotients of school-aged children and the initiation date of prenatal dexamethasone treatment has been established (r = 0.27; p = 0.004).

Сonclusion

Сonclusion. Prenatal DEX-treatment at an early gestation can result in significant adverse effects on intellectual abilities and physical development of children furtheron. 

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The authors declare that there are no conflicts of interest present.