Children born to mothers taking antiseizure medications during pregnancy are at increased risk of autism or intellectual disability, with some drugs posing more risk than others.

New research from Drexel University’s Dornsife School of Public Health suggests that children born to mothers who use antiseizure medications for managing seizures and psychiatric disorders during pregnancy may have a higher risk of developing neurodevelopmental conditions (1^✔ ✔Trusted Source
Antiseizure medication use during pregnancy and children’s neurodevelopmental outcomes

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Study Overview: Data from Over Three Million Children

A recent study, which analyzed data from over three million children in the UK and Sweden, including 17,495 who were exposed to antiseizure medications during pregnancy, found that children exposed to the antiseizure drug lamotrigine in utero did not have an increased risk of autism or intellectual disability compared to those exposed to other antiseizure medications. However, the study linked exposure to valproate, topiramate, and carbamazepine with specific neurodevelopmental issues. These findings were published this month in Nature Communications.

Topiramate Exposure Associated with Higher Risk of Intellectual Disability

However, the absolute risk of neurodevelopmental outcomes in offspring is low, the researchers caution, regardless of the antiseizure drug regimen. Compared to children unexposed to antiseizure medications, those exposed to the drug topiramate during pregnancy were 2.5 times more likely to be diagnosed with intellectual disability, which raises their risk to 2.1% by age 12. In comparison with other drugs available, the authors found very little data suggesting that the drug lamotrigine in pregnancy increases the risk of neurodevelopmental issues in offspring.

“Our findings suggest that while certain medications may pose some risk, lamotrigine may be a less risky option,” said co-senior author Brian K. Lee, Ph.D., a professor at the Dornsife School of Public Health. “Active monitoring of any antiseizure medication is critical to ensure safety and effectiveness, particularly during pregnancy.”

Study Results Challenge Earlier Findings on ADHD and Antiseizure Drugs

This study contrasts earlier studies in that it did not find a statistically significant link between topiramate or levetiracetam and ADHD in children, regardless of whether the birthing parent had an epilepsy diagnosis.

According to the researchers, the data does not argue against the use of antiseizure medications in patients who benefit but rather encourages these patients to have a conversation with their doctor to determine if their course of treatment is most appropriate for them.

The Need for Personalized Medication Plans

“Decisions should be made that are tailored to individual patients,” said co-lead author Paul Madley-Dowd, Ph.D., a research fellow at the University of Bristol. “Stopping antiseizure medications can cause individual harm and harm to offspring, so these conversations always need to happen with a clinician.”

Consistent Findings Across Research on Valproate, Topiramate, and Carbamazepine

This study supports findings from previous research that link the antiseizure drugs valproate, topiramate, and carbamazepine with neurodevelopmental diagnoses in offspring, such as autism, intellectual disability and ADHD. Previous studies in smaller populations also link in utero exposure to these drugs with neurodevelopmental outcomes in offspring, such as ones linking topiramate and intellectual disability, and those associating valproate and lower IQ.

The study utilized data on drug prescriptions in the United Kingdom, and dispensation and self-reported data on drug use in Sweden, as well as electronic health records data for diagnoses. The authors conducted a sibling analysis to help minimize the influence of other factors, such as the severity of diagnosis and underlying genetics, that may influence the results.

Consulting with Physicians Crucial for Pregnant or Preconception Patients

“The link between these drugs and children’s neurodevelopmental outcomes is there, even if the risk isn’t much higher than it is in the unexposed population,” said co-lead author Viktor H. Ahlqvist, a postdoctoral researcher at Karolinska Institutet. “If you’re pregnant or trying to become pregnant, and taking one of these medications, it may be worth talking with your physician to make sure you’re taking the best medicine for your needs, while minimizing risk to future children.”

Despite the study’s large sample size, the authors say patients could benefit from further research from multiple countries on the safety of these drugs as the landscape of options available to patients changes.

Reference:

1. Antiseizure medication use during pregnancy and children’s neurodevelopmental outcomes – (https://www.nature.com/articles/s41467-024-53813-1)

Source-Eurekalert