Children of women with epilepsy who took the antiseizure drugs (ASM) lamotrigine and levetiracetam during pregnancy were not at increased risk of developmental delays by the age of 3 years. This is evident from study results presented at the 73rd American Academy’s virtual meeting April 17-22, 2021.1
“Having a seizure during pregnancy can harm not only the mother but also potentially the baby, so seizure control is an important part of prenatal care,” said Dr. Kimford J. Meador, professor in the Department of Neurology and Neurology Science at Stanford University School of Medicine. “However, ASMs are known to cause birth defects or neurological behavior problems. However, these effects vary widely, with some ASMs at very low risk and others at significant risk. While the risks for some drugs are known and careful planning can result in healthy pregnancies, there are some newer drugs for which the longer-term effects are not fully understood. “2
The study included pregnant women with epilepsy (n = 275) or healthy pregnant women (n = 77). In the epilepsy group, nearly two-thirds of women were taking monotherapy, with 43% taking lamotrigine and 37% taking levetiracetam. Almost a quarter of women with epilepsy (22%) received polytherapy, with 44% of these women taking a combination of lamotrigine and levetiracetam. 4% of women in the total cohort reported no drug use.
The primary result was the verbal index score in offspring aged 3 years. This score is calculated by averaging the Differential Ability Scales-II (DAS-II) sub-tests for Vocabulary Naming and Verbal Comprehension, Preschool Language Expression and Listening Subscales, and Peabody Picture Vocabulary Test-4.
Results in children aged 3 years and over
The researchers found that there were no differences in verbal index scores between children born to mothers with epilepsy and children born to mothers without disease (103.4 and 102.7, respectively) according to the mother’s IQ, education and maximum ASM blood levels were adjusted in the third trimester. In addition, a secondary analysis of the DAS-II nonverbal index results and general conceptual ability did not reveal any difference in the results.
Influence of the results on the declaration of consent
“While more research is needed, our study results are reassuring for women with epilepsy who may be considering pregnancy because we did not find any neurodevelopmental or neuropsychological problems in 3-year-old children associated with ASM,” said Dr. Meador. “If a woman of childbearing potential is given ASM, she should be briefed by her doctor about the risks during pregnancy and discuss the best medications to control seizures and minimize risks to the baby.”
“This informed consent should be given if the drug is prescribed well in advance of epilepsy,” said Dr. Meador. The discussion of the risks should include the fact that, with the exception of pregnancies with some older AEMs (e.g. valproate), most children born to women with epilepsy do not have adverse outcomes, he noted.
One limitation of the study was that cognitive ratings by age 3 didn’t predict outcomes in adolescence and adulthood as well as ratings in old age. Most of the women were also taking lamotrigine and / or levetiracetam; As a result, the data was limited for many ASMs. In addition, the distribution of medications taken by women in this study may not reflect the use of AEMs in the general population. A unique strength of the study is that ASM levels were assessed after monitoring metabolic changes during pregnancy, said Dr. Meador.
The study was supported by the National Institutes of Health, the National Institute of Neurological Disorders and Stroke, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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References
1. Meador K, Cohen M, Loring D, Brown C, Robalino C, Pennell P. Fetal antiseizure medication effects on neuropsychological outcomes at 3 years of age in the MONEAD study. Accessed March 22, 2021.
2. Do epilepsy drugs taken during pregnancy affect a child’s development? Press release. American Academy of Neurology; March 4, 2021. Accessed March 20, 2021. https://www.eurekalert.org/pub_releases/2021-03/aaon-dem021821.php
This article originally appeared on Clinical Advisor
