Antiseizure drugs during pregnancy may affect neurodevelopment
Children whose mothers have taken antiseizure drugs during pregnancy are more likely than others to receive a neuropsychiatric diagnosis. This is according to a comprehensive study by researchers at Karolinska Institutet and elsewhere, published in Nature Communications. However, the researchers emphasise that the absolute risk is low.
Antiseizure drugs are used to treat epilepsy and to stabilise mood in certain psychiatric conditions. However, some of these drugs, such as valproate, are known to affect the foetus if used during pregnancy.
The current study included data from over three million children in the UK and Sweden, 17,495 of whom had been exposed to antiseizure drugs during pregnancy.
As expected, children exposed to valproate were more likely to be diagnosed with autism, intellectual disability or ADHD compared to children not exposed to antiseizure drugs. Children exposed to topiramate had a 2.5-fold increased risk of intellectual disability, while those exposed to carbamazepine had a 25 per cent increased risk of being diagnosed with autism and a 30 per cent increased risk of intellectual disability.
No increased risk with lamotrigine
However, the researchers found no evidence that taking the antiseizure drug lamotrigine during pregnancy increases the risk of neuropsychiatric diagnoses in the child.
“Our findings suggest that while certain medications may pose some risk, lamotrigine may be a less risky option, but active monitoring of any antiseizure medication is critical to ensure safety and effectiveness, particularly during pregnancy,” says Brian K. Lee, Professor at Drexel University Dornsife School of Public Health, USA, and affiliated researcher at the Department of Global Public Health, Karolinska Institutet, Sweden.
The researchers emphasise that the absolute risk of the child receiving a neuropsychiatric diagnosis is low and that there may also be risks associated with not taking antiseizure medication during pregnancy.
“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 minimising risk to future children,” says Viktor H. Ahlqvist, researcher at the Institute of Environmental Medicine, Karolinska Institutet, and joint first author with Paul Madley-Dowd at the University of Bristol, UK.
Support previous findings
The results support previous findings from smaller studies that found links between antiseizure drugs during pregnancy and the risk of neuropsychiatric diagnoses in the child. One difference is that the new study found no statistically significant association between topiramate or levetiracetam and ADHD in the child.
Professor Cecilia Magnusson from the Department of Global Public Health at Karolinska Institutet also participated in the study, which was funded by the National Institutes of Health, the Erik and Edith Fernström Foundation for Medical Research, Karolinska Institutet and the Swedish Society for Medical Research. Some of the authors have received honoraria from companies outside the current work. See the scientific article for more information on potential conflicts of interest.
This news article is based on a press release from Drexel University.
Publication
“Antiseizure Medication Use During Pregnancy and Children's Neurodevelopmental Outcomes”, Paul Madley-Dowd, Viktor H. Ahlqvist, Harriet Forbes, Jessica E. Rast, Florence Z. Martin, Caichen Zhong, Ciarrah-Jane S. Barry, Daniel Berglind, Michael Lundberg, Kristen Lyall, Craig J. Newschaffer, Torbjörn Tomson, Neil M. Davies, Cecilia Magnusson, Dheeraj Rai, Brian K. Lee, Nature Communications, online 15 November 2024, doi: 10.1038/s41467-024-53813-1.