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
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Research Support, Non-U.S. Gov't
MeSH terms
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Abnormalities, Drug-Induced / epidemiology
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Abnormalities, Drug-Induced / etiology*
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Abnormalities, Multiple / chemically induced*
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Abnormalities, Multiple / epidemiology
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Anticoagulants / administration & dosage
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Anticoagulants / adverse effects*
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Anticoagulants / pharmacology
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Anticoagulants / therapeutic use
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Child
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Child Behavior / drug effects
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Cognition / drug effects
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Cohort Studies
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Coumarins / administration & dosage
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Coumarins / adverse effects*
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Coumarins / pharmacology
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Coumarins / therapeutic use
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Developmental Disabilities / chemically induced*
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Developmental Disabilities / epidemiology
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Dose-Response Relationship, Drug
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Female
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Fetus / drug effects
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Follow-Up Studies
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Gestational Age
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Growth Disorders / chemically induced*
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Growth Disorders / epidemiology
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Humans
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Intelligence / drug effects*
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Intelligence Tests
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Male
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Maternal-Fetal Exchange
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Neurologic Examination
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Pregnancy
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Pregnancy Complications, Hematologic / drug therapy*
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Pregnancy Outcome
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Prenatal Exposure Delayed Effects*
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Puberty / drug effects
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Risk