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No Difference in Neurodevelopmental Outcomes With Fetal Antiseizure Drug Exposure
Neurodevelopmental outcomes did not differ between 3-year-olds who were exposed to antiseizure medications in utero and their peers who were not exposed, according to a study published in The Lancet Neurology.
The latest investigation from the prospective, observational Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study, launched 2 decades ago to provide high-quality data on the effect of antiseizure drugs on both mothers and children, focused on children’s neuropsychological outcomes at 3-years-old. Although commonly used medications such as lamotrigine and levetiracetam are typically considered safe and effective compared with first-generation epilepsy medications that carried significant risks to unborn children, the new findings should bring reassurance to patients and neurologists, the research team explained.
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“A blanket saying that all antiseizure medications are bad is overly simplistic and doesn’t make sense biologically,” said study senior author Page Pennell, MD, professor and chair of neurology at the University of Pittsburgh, Pennsylvania. “Being able to say that ‘no, taking these medications will not put their future child at a greater risk of autism or learning disabilities’ has a huge impact for women with epilepsy who are considering pregnancy.”
The study included 351 pregnant women with epilepsy and 105 pregnant women without epilepsy between December 19, 2012, and January 13, 2016. To test whether exposure to antiseizure medication was associated with long-term neurodevelopment effects, researchers tested children at age 3 on their vocabulary skills, verbal comprehension, and ability to describe simple pictures.
Children with fetal exposure to newer antiseizure medications had verbal index scores on par with children without such exposure, according to the study. Researchers reported an adjusted least-square mean of 102.7 for children of women with epilepsy and 102.3 for the children of women without epilepsy.
High levetiracetam dosage in the third trimester, however, was associated with adverse neurodevelopmental effects in a secondary analysis. Consequently, researchers advised careful monitoring of blood levels of levetiracetam as well as further research to determine if other antiseizure drugs have a similar association.
Additionally, increased maternal anxiety and, to a lesser extent, depression were associated with adverse effects in young children, the study found.
“The adverse effects of maternal post-birth anxiety emphasise the importance of screening mothers during pregnancy and postpartum and implementing interventions,” researchers concluded. “Additional studies are needed to clarify the exposure-dependent effects.”
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