Department of Women's and Children's Health, Karolinska Institutet, Pediatric Endocrinology Unit (QB83), Karolinska University Hospital, Stockholm, Sweden.
Section for Cognitive Systems, DTU Compute, Technical University of Denmark Lyngby, Denmark.
J Clin Endocrinol Metab. 2020 Nov 1;105(11):e4074-82. doi: 10.1210/clinem/dgaa611.
Prenatal dexamethasone (DEX) treatment is sometimes used in pregnancies at risk for congenital adrenal hyperplasia (CAH) to prevent virilization in female fetuses with CAH. In boys and in fetuses not having CAH, there is no benefit of early DEX treatment and the risks of this therapy must be thoroughly investigated. High doses of prenatal glucocorticoid might alter the developmental trajectory of the brain into adulthood, even for CAH unaffected subjects treated with DEX for a short term during the first trimester.
The present study investigated brain activation during working memory performance in DEX-treated subjects compared with controls.
DESIGN, SETTING, AND PARTICIPANTS: We tested 18 participants who were exposed to DEX during the first trimester of fetal life but did not have CAH (8 females; mean age 20.78 [standard deviation (SD), 2.67] years) and 40 control participants (24 females; mean age 20.53 [SD, 2.64]) from a single research institute. Participants underwent functional magnetic resonance imaging on a 3T scanner during a verbal and visuospatial working memory task.
We did not observe any differences in brain activity during working memory performance. However, DEX-treated subjects responded faster during the experimental condition of the verbal WM task.
First trimester DEX treatment did not seem to result in altered working memory-related brain activity at adult age. Our findings contribute to the risk-benefit assessment of prenatal DEX treatment in the context of CAH.
在有先天性肾上腺皮质增生症（CAH）风险的妊娠中，有时会使用产前地塞米松（DEX）治疗来防止 CAH 女性胎儿的女性化。在男孩和没有 CAH 的胎儿中，早期 DEX 治疗没有益处，必须彻底调查这种治疗的风险。产前糖皮质激素的高剂量可能会改变大脑在成年期的发育轨迹，即使是患有 CAH 的受试者，在妊娠早期接受短期 DEX 治疗也会受到影响。
本研究调查了在接受 DEX 治疗的受试者与对照组相比，在执行工作记忆任务时大脑的激活情况。
设计、地点和参与者：我们测试了 18 名参与者，他们在胎儿生命的第一个三个月内暴露于 DEX 中，但没有 CAH（8 名女性；平均年龄 20.78 [标准差（SD），2.67] 岁）和 40 名对照参与者（24 名女性；平均年龄 20.53 [SD，2.64]），他们均来自一个单一的研究机构。参与者在 3T 扫描仪上进行了言语和视空间工作记忆任务的功能磁共振成像。
我们在执行工作记忆任务时没有观察到大脑活动的任何差异。然而，DEX 治疗组在言语 WM 任务的实验条件下反应更快。
在成年期，第一个三个月的 DEX 治疗似乎不会导致与工作记忆相关的大脑活动改变。我们的研究结果为 CAH 背景下产前 DEX 治疗的风险效益评估做出了贡献。
