Maternal antiseizure medication not tied to adverse outcomes in offspring

Reuters Health - 10/06/2021 - Developmental outcomes at 2 years are similar for offspring of women who took antiseizure medication for epilepsy during pregnancy and children of women without epilepsy, a new study suggests.

Researchers examined data on 292 children of women with epilepsy and 90 children of healthy women who were assessed at 2 years using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). The primary goal of the study was to determine if there is an association between BSID-III language domain scores in the children and third-trimester antiseizure medication exposure for offspring of women with epilepsy.

There were no significant differences in language scores between children of healthy women and children of mothers using antiseizure medication during their third trimester in an analysis adjusted for mother's IQ, educational level, and postpartum anxiety, as well as children's ethnicity, sex, and birth weight.

In addition, researchers found no significant differences between groups on BSID-III scores for four other domains examined: motor, cognitive, social-emotional, and general adaptive, the study team reports in JAMA Neurology.

These results are not completely unexpected, and may be explained in part by the age children were tested as well as the types of antiseizure medications women used during pregnancy, said lead author Dr. Kimford Meador of the Stanford University School of Medicine and Stanford Neuroscience Health Center in Palo Alto, California.

"First, cognitive testing at 2 years is not as sensitive as testing at older ages; our primary outcome will be at 6 years which is more predictive of school performance and ultimate adult cognitive abilities," Dr. Meador said by email.

Second, the majority of women with epilepsy who took antiseizure medications use lamotrigine or levetiracetam, which are two antiseizure medications that appear to be generally safe in pregnancy, Dr. Meador said.

"It has been previously shown that the reduced use of older antiseizure medications in pregnancy such as valproate is associated with a reduction in congenital malformations," Dr. Meador said. "It appears that we are seeing the same thing here for cognitive and behavioral problems."

However, in secondary analysis, the study did find exposure to higher levels of antiseizure medications in the third trimester were associated with lower BSID-III scores for the general adaptive domain and motor domain.

One limitation of the study is that the prescribing patterns at epilepsy treatment centers that enrolled participants may differ from other settings, resulting in outcomes that may not be generalizable to offspring of all women with epilepsy who use antiseizure medications, the study team notes.

Even so, the results should be reassuring to pregnant women on lamotrigine and levetiracetam who continue treatment during pregnancy, said Dr. Torbjörn Tomson, a senior professor in clinical neuroscience at the Karolinska Institutet in Stockholm and co-author of an editorial accompanying the study.

"Treatment during pregnancy with lamotrigine and levetiracetam is likely to be safe with respect to cognitive outcomes in the exposed children at two years of age, but data on other newer generation antiseizure medications is insufficient," Dr. Tomson said by email. "Regardless of the type of antiseizure medication, clinicians should strive for using the lowest effective dose for the individual woman during pregnancy."

SOURCE: https://bit.ly/3vcbnYq and https://bit.ly/3xaWAhU JAMA Neurology, online June 7, 2021.

By Lisa Rapaport



Posted on 10 June 202128 June 2021