No link between antiseizure drugs during pregnancy, neurodevelopmental outcomes in kids
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Key takeaways:
- Verbal abilities were similar in children exposed to antiseizure medication in the third trimester vs. those who were not.
- Folate use in the first 12 weeks of pregnancy improved cognition and behavior outcomes.
Children of women prescribed antiseizure medications for epilepsy during pregnancy did not have worse neurodevelopmental outcomes by age 6 compared with children of women who did not receive them, according to new research.
“The effects of antiseizure medicines given during pregnancy are not known at later time points,” Adam Hartman, MD, program director at the NIH’s National Institute of Neurological Disorders and Stroke, told Healio in an email regarding the data published in JAMA Neurology. “This study fills that knowledge gap at a critical time in the child’s development.
Although commonly prescribed, the teratogenic properties of antiseizure medications (ASMs) given to pregnant women with epilepsy are not fully understood and have the potential to cause neurodevelopmental impairments and delays in offspring. Conversely, prior research established folate supplementation early in pregnancy was associated with improved outcomes.
The researchers compared outcomes of children aged 6 years of 351 women with epilepsy vs. 105 healthy women, while examining associations of outcomes from exposure to ASMs in the third trimester.
The MONEAD study was a prospective, observational, nonrandomized clinical trial conducted at 20 specialty epilepsy centers.
From an initial cohort of 451 children, a total of 298 children born to women with epilepsy and 89 controls were included in the primary analysis. The children were assessed between 2019 and 2022.
The primary outcome was Verbal Index Score (VIS), which was based on a battery of neuropsychological testing that included verbal, visual and memory, processing and comprehension assessments.
Additional analyses examined the association between VIS and third-trimester ASM blood concentration as well as outcomes related to folate exposure.
Most of the women with epilepsy received lamotrigine or levetiracetam, or a combination of the two drugs.
According to the results, there were no significant differences in VIS among children of women with epilepsy who received ASM and controls.
In both unadjusted and adjusted analyses, there was no correlation between VIS and third-trimester ASM blood concentration, save for a negative association with levetiracetam.
Data additionally showed that folate supplementation within the first 12 weeks of pregnancy demonstrated beneficial effects on cognition and behavior, even at higher doses, by age 6. However, the researchers acknowledged more information is required regarding longer term risks associated with these high doses.
“What makes this study meaningful is that when you assess a child at 6, the tests are a lot more sensitive than at earlier ages, especially 2-year-olds,” Kimford J. Meador, MD, study co-lead author and professor in the department of neurology and neurological sciences, Stanford Neuroscience Health Center, Stanford University School of Medicine, said in a related release. “There’s measurable impact on school performance and results are more predictive of adult cognitive ability.”
Reference:
Newer epilepsy medications used during pregnancy do not affect neurological development in children. https://www.nih.gov/news-events/news-releases/newer-epilepsy-medications-used-during-pregnancy-do-not-affect-neurological-development-children. Published Nov. 27, 2024. Accessed Dec. 2, 2024.