Children whose mothers take antiseizure medications during pregnancy, whether for managing seizures or mental health issues, might experience a higher likelihood of developing neurodevelopmental disorders, as suggested by recent research from Drexel’s Dornsife School of Public Health.
A new study from researchers at Drexel’s Dornsife School of Public Health indicates that children born to mothers who use antiseizure medications for seizure control and psychiatric conditions during pregnancy may be at higher risk for neurodevelopmental disorders.
This research, which analyzed data from over three million children in the United Kingdom and Sweden—including 17,495 who were exposed to antiseizure drugs in utero—found that exposure to the antiseizure medication lamotrigine during pregnancy did not significantly increase the risk of autism or intellectual disability compared to other antiseizure medications. In contrast, the use of valproate, topiramate, and carbamazepine was associated with specific neurodevelopmental challenges. The results were released this month in the journal Nature Communications.
Despite these findings, the researchers emphasize that the overall risk of neurodevelopmental issues in children remains low, even with different antiseizure medications. For example, children exposed to topiramate in utero were found to be 2.5 times more likely to develop intellectual disabilities, raising their risk to 2.1% by age 12. Comparatively, there is limited evidence that lamotrigine raises the chances of neurodevelopmental disorders in children compared to other medications.
According to co-senior author Brian K. Lee, PhD, a professor at Dornsife School of Public Health, “Our findings suggest that while some medications may carry risks, lamotrigine appears to be a safer alternative.” He underlined the importance of continuously monitoring any antiseizure medication to ensure it remains safe and effective during pregnancy.
This research challenges earlier studies that identified a significant connection between topiramate or levetiracetam and ADHD in children, regardless of whether the mother had epilepsy.
The researchers state that their findings do not discourage the use of antiseizure medications for patients who find them beneficial. Instead, they recommend discussing treatment options with a healthcare provider to ensure the best course of action for individual needs.
Co-lead author Paul Madley-Dowd, PhD, a research fellow at the University of Bristol, noted, “Medical decisions should be personalized. Ceasing antiseizure medications can lead to significant harm for both the individual and their children, making these discussions critical with a clinician.”
This study bolsters previous research correlating the antiseizure drugs valproate, topiramate, and carbamazepine with neurodevelopmental disorders such as autism, intellectual disability, and ADHD. Earlier studies involving smaller cohorts have also linked prenatal exposure to these drugs with adverse developmental outcomes, including topiramate’s association with intellectual disabilities and valproate’s relationship with reduced IQ.
The research employed prescription data from the UK and reports of drug usage from Sweden, alongside electronic health records for assessing diagnoses. The authors also performed a sibling comparison analysis to diminish the impact of other factors, such as severity of illness and genetics, that could affect the results.
Co-lead author Viktor H. Ahlqvist, a postdoctoral researcher at Karolinska Institutet, remarked, “The connection between these medications and neurodevelopmental outcomes exists, even if the increased risk is not significantly higher than for those not exposed.” He advised that if individuals are pregnant or planning to conceive while on these medications, they should consult their healthcare provider to ensure they are receiving the most suitable treatment with minimal risk to future children.
Even with the considerable size of this study’s sample, the authors advocate for further research in various countries to assess the safety of these drugs as the range of treatment options for patients continues to evolve.
In addition to Lee, Madley-Dowd, and Ahlqvist, other researchers involved include co-senior authors Cecilia Magnusson from the Karolinska Institutet and Dheeraj Rai from the University of Bristol, as well as collaborators from Drexel University, Pennsylvania State University, London School of Hygiene and Tropical Medicine, University College London, and the Karolinska Institutet.
This research was funded by the National Institutes of Health (1R01NS107607).
