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Neurological outcome in school-age children after in utero exposure to coumarins
J Wesseling1, D Van Driel, M Smrkovsky
1Department of Paediatrics, Beatrix Children's Hospital, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, Netherlands.
Insights
Prenatal exposure to coumarin medications increases the risk of minor neurological dysfunction (MND) in school-aged children. This risk is higher with second or third-trimester exposure and shows a dose-response relationship.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Pharmacology
Background:
- Prenatal exposure to certain medications can impact child development.
- Coumarins are anticoagulant medications used during pregnancy.
- The long-term neurological effects of prenatal coumarin exposure require further investigation.
Purpose of the Study:
- To assess the neurological outcomes in children exposed prenatally to coumarin derivatives.
- To determine the association between gestational coumarin exposure and minor neurological dysfunction (MND).
Main Methods:
- A cohort study comparing 306 children exposed to coumarins in utero with 267 matched unexposed children.
- Neurological examinations focused on identifying minor neurological dysfunction (MND).
- Statistical analysis included calculating odds ratios (OR) and confidence intervals (CI).
Main Results:
- No children exhibited severe neurological abnormalities.
- Prenatal coumarin exposure was associated with an increased risk of MND (OR 1.9).
- Exposure during the second or third trimester showed a higher risk (OR 2.1), with a dose-response relationship observed.
Conclusions:
- Gestational coumarin exposure is linked to an increased risk of mild neurological dysfunction in school-aged children.
- The findings suggest coumarins may influence brain development, leading to subtle neurological deficits.
- Further research is warranted to understand the mechanisms and long-term implications.
Abstract:
The effect of prenatal exposure to coumarins (acenocoumarol, phenprocoumon) on neurological outcome was assessed in a cohort of 306 children aged 7-15 years. Findings were compared with those in a non-exposed cohort of 267 children, matched for sex, age, and demographic region. We used a neurological examination technique which pays special attention to minor neurological dysfunction (MND). None of the children was found to be neurologically abnormal. However, exposure to coumarins during gestation increases the risk for MND in children of school age, odds ratio (OR) 1.9 (CI(95) 1.1-3.4), predominantly after exposure in the second or third trimester, odds ratio 2.1 (CI(95) 1.2-3.8). We found a dose-response relationship with an odds ratio of 1.2 (CI(95) 1.0-1.5) per mg coumarin derivative prescribed per day. The results suggest that coumarins have an influence on the development of the brain which can lead to mild neurological dysfunctions in children of school age.
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