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Behavioural outcome of school-age children after prenatal exposure to coumarins
J Wesseling1, D Van Driel, H S Heymans
1Department of Paediatrics, Beatrix Children's Hospital, University Hospital Groningen, PO-Box 30.001, 9700 RB, Groningen, The Netherlands.
Insights
Prenatal exposure to coumarin derivatives can negatively impact school-aged children's behavior, affecting task orientation and social-emotional skills. However, this exposure did not significantly increase clinically relevant problem behaviors in children.
Area of Science:
- Developmental Psychology
- Neurodevelopmental Toxicology
- Pediatric Behavioral Health
Background:
- In utero exposure to coumarin derivatives is suspected to impact fetal central nervous system development.
- Long-term developmental effects of prenatal coumarin exposure remain largely uncharacterized.
- Understanding the impact on school-aged children's behavior is crucial for early intervention.
Purpose of the Study:
- To investigate the long-term behavioral outcomes in children exposed prenatally to coumarins.
- To assess if prenatal coumarin exposure affects behavioral development at school age.
- To compare behavioral patterns between exposed children and non-exposed controls.
Main Methods:
- A cohort study involving 305 children (aged 7-15) with in utero coumarin exposure and 263 matched controls.
- Parental and teacher ratings of child behavior using the Groningen Behaviour Checklist Family situation (GBF) and School situation (GBS).
- Blinded assessment by teachers to control for exposure bias.
Main Results:
- Coumarin-exposed children exhibited lower 'positive task orientation' scores (GBF P<0.05, GBS P<0.01).
- Exposed children showed higher 'emotional instability' (GBF P<0.001, GBS P<0.05) and more social difficulties (P<0.01).
- No significant increase in clinically relevant problem behavior was observed (OR 1.2, CI 95% 0.7-1.8).
Conclusions:
- Prenatal coumarin exposure is associated with less favorable task-oriented and social-emotional behavior in school-aged children.
- Behavioral development may be negatively influenced by in utero coumarin exposure.
- While specific behavioral clusters are affected, overall clinically significant problem behavior frequency was not elevated.
Abstract:
In utero exposure to coumarin derivatives may affect the development of the central nervous system of the child, irrespective of the period of exposure in pregnancy. Little is known about effects on development in the long term. The aim of the present study was to determine whether prenatal exposure to coumarins affects behavioural outcome in children at school age. Behavioural outcome was assessed in a cohort of 305 exposed children, aged 7-15 years. Findings were compared with those in a cohort of 263 non-exposed controls, matched for sex, age, and demographic region. Behaviour was rated by parents and teachers using standardized questionnaires: the Groningen Behaviour Checklist Family situation (GBF) and the Groningen Behaviour Checklist School situation (GBS), respectively. The findings of the GBF were supported by the results of the GBS, filled in by teachers who were blind for the exposure status of the child. In comparison to the non-exposed children, the coumarin-exposed children scored lower on the cluster 'positive task orientation' (GBF P<0.05, GBS P<0.01), they scored higher on 'emotional instability' (GBF P<0.001, GBS P<0.05), and they had more problems on the social clusters (P<0.01). Based on the results of both questionnaires, we conclude that behavioural development may be negatively influenced in school-age children after in utero exposure to coumarins, leading to less favourable task-oriented and social-emotional behaviour. However, the frequency of clinically relevant 'problem behaviour' (GBF) was not increased in relation to coumarin exposure, the odds ratio was 1.2 (CI(95) 0.7-1.8).
