Q: I have read several articles about the use of Dex during pregnancy to treat a possibly CAH effected fetus. I have not seen any info about best treatment for a mother with CAH during pregnancy when the fetus will not be effected with CAH?

I have had two pregnancies, both were difficult due to a lot of illnesses and infections. When I am on dex these things are better controlled for me, but during pregnancies I switched to prednisone and don’t feel as well controlled.

So I guess my question is what are the real risks of remaining on dex as MY treatment when my child will not have CAH?

A: Because the long-term safety of dexamethasone on a developing fetus has not been well-established, the use of dexamethasone during pregnancy without a specific indication (e.g. prenatal treatment of an affected female) is not recommended. Prednisone has some crossing of the placenta and is not our preferred treatment. Hydrocortisone does not cross the placental barrier and is considered the safest treatment during pregnancy for mothers who require treatment for their own medical condition.

Q: My daughter was diagnosed with LOCAH recently. She is currently on cortef 3X a day. In a variety of websites, they mentioned that with CAH you should exercise, but competitive sports were discouraged. She is currently doing competitive cheer. I worry about the safety, but is there another reason for these comments? And, is this a referencing to people with a more severe case of CAH?

A: Exercise is indeed recommended for everyone, particularly to stave off the risk of weight gain that can be associated with chronic glucorticoids.
Extremely vigorous sports is not necessarily contraindicated for CAH, but patients with the severe salt-wasting form do need to take certain precautions to ensure that they do not develop hyponatremia (low sodium) or hypoglycemia (low blood sugar). In severe hot weather, excessive sweating can lead to salt loss as well as dehydration, so they need to take frequent breaks for fluids with electrolytes and carbohydrates. For the milder form of CAH, there is no reason not to participate in competitive sports; however, your daughter is at risk for an adrenal crisis since she is taking chronic glucocorticoids. Therefore, she should wear a medical alert bracelet that states she has “adrenal insufficiency” and have injectable Solu-Cortef on hand in the event that she has a traumatic injury.