Coumarins during pregnancy: long-term effects on growth and development of school-age children

Thromb Haemost. 2001 Apr;85(4):609-13.

Abstract

Anticoagulation during pregnancy is complicated because of potential risks for mother and foetus. Unfractionated or low-molecular-weight heparin is used for most anticoagulant indications. Its efficacy, however, in pregnant women with prosthetic heart valves is questioned, therefore coumarins are preferred for this indication. We studied long-term effects of prenatal coumarin-exposure on growth and on neurological, behavioural and cognitive development in 274 school-age children in comparison with 231 age-matched non-exposed controls. No major abnormalities were found. The exposed children had an increased risk for minor neurological dysfunction and for a low intelligence quotient (IQ below 80). The risk for a combination of two or more (minor) abnormalities was higher for the exposed children, RR = 7.6. We conclude that prenatal exposure to coumarins is associated with an increased risk for disturbances in development in school-age children. However, for the vast majority of children there is no clinical significant effect on growth and long-term development.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abnormalities, Drug-Induced / epidemiology
  • Abnormalities, Drug-Induced / etiology*
  • Abnormalities, Multiple / chemically induced*
  • Abnormalities, Multiple / epidemiology
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects*
  • Anticoagulants / pharmacology
  • Anticoagulants / therapeutic use
  • Child
  • Child Behavior / drug effects
  • Cognition / drug effects
  • Cohort Studies
  • Coumarins / administration & dosage
  • Coumarins / adverse effects*
  • Coumarins / pharmacology
  • Coumarins / therapeutic use
  • Developmental Disabilities / chemically induced*
  • Developmental Disabilities / epidemiology
  • Dose-Response Relationship, Drug
  • Female
  • Fetus / drug effects
  • Follow-Up Studies
  • Gestational Age
  • Growth Disorders / chemically induced*
  • Growth Disorders / epidemiology
  • Humans
  • Intelligence / drug effects*
  • Intelligence Tests
  • Male
  • Maternal-Fetal Exchange
  • Neurologic Examination
  • Pregnancy
  • Pregnancy Complications, Hematologic / drug therapy*
  • Pregnancy Outcome
  • Prenatal Exposure Delayed Effects*
  • Puberty / drug effects
  • Risk

Substances

  • Anticoagulants
  • Coumarins