Recent research funded by the National Institutes of Health (NIH) confirms that children born to mothers who took newer anti-seizure medications during pregnancy do not experience adverse neurodevelopmental outcomes by the age of six. The study, published in JAMA Neurology, provides reassurance to women with epilepsy who need to manage their seizures during pregnancy.
“Proper seizure management is a vital part of prenatal care for women with epilepsy. However, the impact of newer anti-seizure medications on child development has been uncertain,” explained Adam Hartman, M.D., a program director at NIH’s National Institute of Neurological Disorders and Stroke (NINDS). The study found no correlation between these drugs and the cognitive abilities of the children, providing a foundation for future research and potentially better dosage guidelines.
Past concerns regarding anti-seizure medication during pregnancy primarily involve older drugs like valproate, which are associated with serious birth defects and cognitive issues in children, such as lower IQ and autism spectrum disorders. However, the effects of newer anti-seizure medications, which are commonly used today, on a child’s cognition after in-utero exposure were not well understood until now.
The study assessed the language abilities of 387 six-year-old children, 298 of whom were born to mothers with epilepsy who took anti-seizure medication. The children’s verbal abilities, including vocabulary and the ability to match spoken words to pictures, were tested. The results showed no significant differences in language scores between children born to mothers who took the medication and those who did not.
According to Kimford Meador, M.D., co-lead investigator of the study and professor of neurology at Stanford University, the results are significant. “Assessing a child at six years old provides a more accurate picture of their cognitive abilities than at earlier ages. This age is more indicative of school performance and better predicts adult cognitive ability,” he said.
However, determining the safest and most effective dosages during pregnancy remains a challenge. Previous studies by the same team indicated that high doses of a drug called levetiracetam could lead to poorer cognitive outcomes in early childhood, but overall, outcomes were positive across all ages.
In addition, the study discovered that the use of folate – an essential nutrient for preventing birth defects in the brain and spine – during the first trimester was linked to better cognitive and behavioral outcomes. This was true even at high doses and was applicable to children of both epileptic and non-epileptic mothers.
The study also found no negative effects of anti-seizure medications on breastfeeding but suggests that further research is needed to understand the risks of high folate doses and less common anti-seizure drugs, including newer ones on the market.
This research, part of the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study, took place in 20 medical centers across the United States. It was led by Dr. Meador and Page Pennell, M.D., chair of neurology at the University of Pittsburgh, and was designed to evaluate the effects of anti-seizure medications on pregnant women with epilepsy and their children, from birth to six years of age.
