Clinical Trial: Prenatal Dex Study

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Multicentric Evaluation of in Utero Dexamethasone (DEX) on the Cognitive Development of Children at Risk of Congenital Adrenal Hyperplasia

Brief Summary: The classic form of 21-hydroxylase deficiency (prevalence 1/15,000) is the most common cause of congenital adrenal hyperplasia (CAH). This autosomic recessive disease is responsible for virilization of the external genitalia in girls through androgen hypersecretion during fetal life. Since 1984, the Lyon Pediatric Endocrinology group has proposed prenatal dexamethasone (DEX) for all fetuses at risk of CAH With the aim of preventing fetal androgen hypersecretion in affected girls and avoiding poor long-term results from reconstructive surgery. Prenatal DEX was used in Europe and the USA but its use was recently suspended: in 2007, a Swedish study conducted on 26 children treated with DEX in utero for a short period of time reported cognitive impairments. These data were not confirmed by an American study on the short-term DEX use, which showed potential cognitive impairments in CAH children exposed to DEX for long periods of time. These confusing and controversial results have caused the scientific community to question its position and have resulted in the suspension of the use of prenatal DEX with drastic consequences for CAH girls (virilization; genital surgery etc.). In this context, an evaluation of neuropsychological development under in utero DEX is essential to validate its indication for use during the prenatal period. This study will evaluate outcomes using prospective cognitive and emotional assessments. It will first focus on the unaffected children previously treated in utero in order to assess the adverse effects of the drug. The study will then assess the children with CAH for whom DEX could have beneficial effects.

Detailed Summary:
Sponsor: Hospices Civils de Lyon

Current Primary Outcome: Intelligence quotient [ Time Frame: 3 months ]

Wechsler Intelligence Scale for Children (WISC) is designed to measure human intelligence. WISC-IV includes:

  • Verbal Comprehension Index: measure of verbal concept formation.
  • Perceptual Reasoning Index: measure of non-verbal and fluid reasoning.
  • Working Memory Index: measure of working memory.
  • Processing Speed Index: measure of processing speed. Data measured: raw score (0 to 150), standard score (1 to 19), index (40 to 160).

The four indexes of the intelligence quotient will be considered hierarchically as follows: first the Working Memory Index, then the Processing Speed Index, third the Perceptual Reasoning Index, fourth the Verbal Comprehension Index.



Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Children Memory Scale (CMS) [ Time Frame: 3 months ]

    Neurocognitive profile of children assessed by Children Memory Scale (CMS) at Visit 2.

    Memory tests: Children Memory Scale (CMS), the following composites will be considered in our study:

    • Immediate and delayed visual memory : face recognition and dot location
    • Immediate and delayed verbal memory, recognition : stories, word pairs
    • Learning: dot location and word pairs
    • Attention, concentration: numbers, sequences
  • Rey figure test [ Time Frame: 3 months ]
    Neurocognitive profile of children assessed by visuoperceptual test (Rey Figure test) at Visit 2
  • Revised - Child Measure of Anxiety Scale (R- CMAS) score [ Time Frame: 15 months ]
    Emotional profile assessed by Revised - Child Measure of Anxiety Scale (R- CMAS) score
  • Mood Depressive Inventory for Children (MDI- C) score [ Time Frame: 15 months ]
    Emotional profile assessed by Mood Depressive Inventory for Children (MDI- C) score
  • Child Behavior Checklist (CBCL) score [ Time Frame: 15 months ]
    Emotional profile assessed by Child Behavior Checklist (CBCL) score
  • Evaluation of the benefits of in utero DEX in preventing or reducing the virilization of external genitalia in CAH girls [ Time Frame: Day 1 ]
    The anatomical evaluation (phenotyping) of girls' external genitalia was performed at the time of the surgical correction and included the measurement of the genital tubercule (GT), the distance between the perineum and the urethra-vaginal confluence, the degree of fusion of the genital folds (labia majora), their pigmentation and creases. The measurement of the ano-genital distance was not routine practice in the past.


Original Secondary Outcome: Same as current

Information By: Hospices Civils de Lyon

Dates:
Date Received: May 25, 2016
Date Started: October 2016
Date Completion: December 2019
Last Updated: February 21, 2017
Last Verified: February 2017