Lamotrigine, Levetiracetam and Other Antiseizure Medications During Pregnancy Not Associated With Developmental Delays at Age 3 Years

According to a preliminary study, children born to women taking certain antiseizure medications (ASMs) for epilepsy during pregnancy had no higher risk of developmental delays at age 3 years when compared with children of women without epilepsy. 

The study involved 275 individuals with and 77 without epilepsy who all enrolled in the study during pregnancy. Approximately 4% took no medication, 74% took 1 ASM; and 22% took more than 1 ASM. Of the more than 60 individuals who took 2 of more ASMs, almost half took lamotrigine and levetiracetam. Serum levels of ASMs were measured in the third trimester.

At age 3, the children resulting from these pregnancies were evaluated with a series of cognitive and developmental tests that measured skills such as vocabulary, listening comprehension, number recall, and pattern recognition. After adjusting for the mothers’ IQ and education, researchers found no differences in developmental scores between the children exposed to ASMs. Nor were there developmental differences that correlated with serum level of ASMs among the children who were exposed to ASMs. 

In contrast, previous studies have shown a dose-dependent negative correlation of valproate with IQ scores in children who were exposed to valproate as fetuses. The largest positive correlation with children's IQ, however, remains their mothers' highest education level, which is significantly related to social determinants of health. 

“Having a seizure during pregnancy may not only harm the mother but possibly the baby as well, so seizure control is an important part of prenatal care,” said Kimford J. Meador, MD, of Stanford University. “Yet, ASMs are known to cause birth defects or neurobehavioral problems, but these effects vary widely with some having very low risks, but others having substantial risks. While the risks for some ASMs are known, and careful planning can result in healthy pregnancies, there are some newer ASMs for which the longer-term effects are still not fully known. While more research is still needed, our study results are reassuring to women with epilepsy who may be considering pregnancy as we found no neurodevelopmental or neuropsychological problems in children age 3 years linked to ASMs.” 

This study will be presented at the virtual American Academy of Neurology 73rd Annual Meeting