Atropinic burden of drugs during pregnancy and psychological development of children: a cohort study in the EFEMERIS database

Br J Clin Pharmacol. 2016 Aug;82(2):478-86. doi: 10.1111/bcp.12978. Epub 2016 May 29.


Aim: The aim of this study was to evaluate the potential effect of in utero exposure to drugs with atropinic properties on infant psychological development using atropinic burden (AB) scales.

Methods: Women from the EFEMERIS cohort, a French database including prescribed and dispensed reimbursed drugs during pregnancy and pregnancy outcomes, delivering between 2004 and 2010 were included (n = 43 740). Each drug was classified as having no (score = 0), few (score = 1) or strong (score = 3) atropinic properties. AB per woman was calculated by adding the atropinic scores of drugs prescribed during pregnancy. AB was categorized as exposure or no exposure. Secondary analyses were performed by dividing the exposure into four scores = [0], [1-8], [9-17] and [≥18]. Data for psychological development were extracted from children's medical certificates completed at 9 and 24 months.

Results: Thirty-four% (n = 14 925) of women received at least one atropinic drug during pregnancy. Women with AB ≥1 were older and received more drugs during pregnancy than unexposed women. At 24 months, more infants of mothers with AB ≥1 had difficulties to 'name a picture' (ORa , 1.18, 95% CI 1.03, 1.36) and to 'understand instructions' (ORa , 1.61, 95% CI 1.13, , 2.30]) compared with infants of unexposed women. Analyses of four groups of exposure and analyses excluding women receiving psychotropics led to similar results.

Conclusions: The study showed significant association between in utero exposure to drugs with atropinic properties and fewer infant cognitive acquisitions at 24 months. Further exploring the potential effect of simultaneous use of drugs with atropinic effects among pregnant women will bring into consideration whether such prescriptions could be inappropriate for the child.

Keywords: EFEMERIS cohort; atropinic burden; drug risk; pregnancy; psychological development.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Atropine Derivatives / administration & dosage
  • Atropine Derivatives / adverse effects*
  • Child Development / drug effects
  • Child, Preschool
  • Cohort Studies
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • France
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Pregnancy
  • Pregnancy Outcome*
  • Prenatal Exposure Delayed Effects / epidemiology*


  • Atropine Derivatives