Epilepsy Medications Taken During Pregnancy Do Not Affect Child’s Neurological Development

Children of mothers who took certain antiseizure medications while pregnant do not have worse neurodevelopmental outcomes at age 6, according to a long-running study funded by NIH. The study was published in JAMA Neurology.

Treating epilepsy during pregnancy is challenging, as some antiseizure medications, primarily older drugs such as valproate, are known to cause serious birth defects and cognitive problems in children, including lower IQ and autism spectrum disorders. Newer antiseizure drugs widely used today are generally considered safe, but little is known about whether they affect cognition in children after fetal exposure.

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In the study, researchers assessed language abilities in 387 children at age 6 (298 were born to women with epilepsy who took antiseizure medications). Children were tested on a variety of verbal abilities, including vocabulary and matching spoken words to pictures. There were no differences in language scores between children of women who took the medications and those who didn’t. Most women were taking lamotrigine, levetiracetam, or a combination of both drugs during and after pregnancy.

Finding the most effective and safest doses during pregnancy is a challenge, and risks tend to vary between antiseizure drugs. Prior studies from the same research team have shown that high doses of levetiracetam could lead to poorer cognitive outcomes at age 2 and 3, and worse adaptive functioning at age 4 and a half, but the overall outcomes for all ages were positive.

The study also found that folate use during the first 12 weeks of pregnancy was associated with better cognitive and behavioral outcomes. Folate is an essential nutrient that can help prevent birth defects in the brain and spine of a developing fetus. This held true for children of women with and without epilepsy. High doses at or above 4 mg per day did not have adverse effects, which contrasts with prior studies that found long-term risks associated with high doses of folic acid.

Additional analyses also revealed no adverse effects of antiseizure medications on breastfeeding.