Management of Fully Pubertal Girls With Nonclassical Congenital Adrenal Hyperplasia: Glucocorticoids Versus Oral Contraceptives.

OBJECTIVE: To compare clinical outcomes of 3 treatment regimens-glucocorticoids (GCs), oral contraceptives (OCs), or a combination of both-administered to adolescents and young women diagnosed in childhood with nonclassical congenital adrenal hyperplasia (NCCAH), who had been treated with GCs until their adult height was achieved. METHODS: A retrospective study of medical records of 53 female patients with NCCAH followed in 3 tertiary pediatric endocrinology institutes. The 3 treatment groups were compared for the prevalence of hirsutism and acne, standardized body mass index (BMI)-standard deviation score (SDS), and androgen levels at the attainment of adult height (baseline), 1-year later, and at the last documented visit. RESULTS: At baseline, there were no significant differences among groups in BMI-SDS, androgen levels, hirsutism prevalence, acne, or irregular menses. From baseline to the last visit, the rate of hirsutism declined significantly only in the OC group (37.5% vs 6.2%, respectively; P = .03). The rate of acne declined in the combined group (50% vs 9%, respectively; P = .03) with a similar tendency in the OC group (50% vs 12.5%, respectively; P = .05). No significant changes were observed in BMI-SDS for the entire cohort or any subgroup during follow-up. A significant rise in androstenedione (P < .001), testosterone (P < .01), and 17-hydroxyprogesterone (P < .01) levels was observed only in the OC group. CONCLUSION: In girls diagnosed in childhood with NCCAH, who require treatment for hyperandrogenism following completion of linear growth, management should be tailored individually using a patient-centered approach. Treatment with OCs might be better than that with GCs for regression of hirsutism and acne. The long-term effects of elevated levels of androgens associated with this treatment regimen should be further studied.

"Neglected moms" - The implications of emotional neglect in childhood for the transition to motherhood.

BACKGROUND: The transition to motherhood involves many challenges that require adjustment; included among them are adapting to body changes, forging a maternal identity, and attaching to the baby. Although these tasks may not be easy for any women, those who experienced emotional neglect during childhood may find them especially difficult. OBJECTIVE: The aim of the current study was to examine a model illuminating the mechanism underlying the association between childhood emotional neglect and women's adjustment during pregnancy and the postpartum period. PARTICIPANTS AND SETTING: Three hundred and ninety four Israeli women participated in the study, during their pregnancy (Time 1) and two months postpartum (Time 2). METHODS: Participants filled out a battery of questionnaires assessing their history of childhood emotional neglect, body experience, maternal self-efficacy, attachment to the fetus/baby, and depression. RESULTS: Results from structural equation modeling (SEM) indicated that childhood emotional neglect was associated with depression at both Time 1 and Time 2. These associations were mediated by the body experience during pregnancy (Time 1) and motherhood (Time 2) as well as by anticipated maternal self-efficacy (Time 1) and maternal self-efficacy (Time 2). The model explained 56% of the variance of postpartum depression (Time 2). CONCLUSIONS: These findings point to the long-term implications of childhood emotional neglect for women's adjustment to the transition to motherhood. The underlying mechanism suggested by the research model is discussed.