van Driel D, Wesseling J, Sauer P J, van Der Veer E, Touwen B C, Smrkovsky M
Department of Pediatrics, Beatrix Children's Hospital, University Hospital Groningen, The Netherlands.
Pediatrics. 2001 Jan;107(1):123-9. doi: 10.1542/peds.107.1.123.
To assess the cognitive abilities in school-aged children who have been exposed to coumarins in utero.
Coumarin derivatives are an effective option for anticoagulant therapy in pregnant women. However, case reports describe anomalies of the fetal central nervous system after in utero exposure to coumarins. It is unclear whether prenatal exposure has an effect on cognitive functioning later in childhood.
The exposed cohort consisted of 291 children from mothers who were prospectively registered because of coumarin treatment during pregnancy. The nonexposed cohort included 253 age-matched peers. An IQ was estimated using subtests of the Weschler Intelligence Scale for Children-Revised. Educational achievement was examined with tests for reading, spelling, and arithmetic. In addition, schoolteachers were asked to judge performance on language and arithmetic. The observers were not aware of the exposure status of the child.
No differences in mean IQ were found between the exposed and nonexposed cohort (mean difference: -1.1; 95% confidence interval [CI]: -3.2-1.1), but an IQ score below 80 was found in 11 children in the exposed compared with 3 children in the nonexposed cohort (odds ratio [OR] = 3.1; CI: 0.8-11.6). Regarding the tests for educational achievement, exposed children as a group performed as well as nonexposed controls. Exposed boys, in comparison with nonexposed boys, showed a higher frequency of poor performance on reading (OR = 2.9; CI: 1.1-7.4) and spelling (OR = 2.5; CI: 1.0-6.0).
Cognitive functioning in coumarin-exposed children does not differ from nonexposed controls, but a minority of children seem to be prone to the potential negative effects of coumarins during pregnancy.
评估子宫内接触香豆素的学龄儿童的认知能力。
香豆素衍生物是孕妇抗凝治疗的有效选择。然而，病例报告描述了子宫内接触香豆素后胎儿中枢神经系统的异常情况。目前尚不清楚产前接触是否会对儿童后期的认知功能产生影响。
暴露队列由291名儿童组成，其母亲因孕期接受香豆素治疗而被前瞻性登记。非暴露队列包括253名年龄匹配的同龄人。使用韦氏儿童智力量表修订版的子测验来估计智商。通过阅读、拼写和算术测试来检查学业成绩。此外，还请学校教师对语言和算术表现进行评判。观察者不知道孩子的暴露状态。
暴露队列和非暴露队列之间的平均智商没有差异（平均差异：-1.1；95%置信区间[CI]：-3.2-1.1），但暴露队列中有11名儿童智商得分低于80，而非暴露队列中有3名儿童（优势比[OR]=3.1；CI：0.8-11.6）。关于学业成绩测试，暴露组儿童作为一个整体的表现与非暴露对照组相同。与非暴露男孩相比，暴露男孩在阅读（OR=2.9；CI：1.1-7.4）和拼写（OR=2.5；CI：1.0-6.0）方面表现较差的频率更高。
接触香豆素的儿童的认知功能与未接触的对照组没有差异，但少数儿童似乎容易受到孕期香豆素潜在负面影响的影响。
