New epilepsy drugs during pregnancy have no adverse effects on children’s brain development

**Study Indicates No Negative Neurological Impact on Kids from Moms Using Certain Epilepsy Drugs During Pregnancy**
An ongoing study financed by the National Institutes of Health (NIH) has found that children of mothers who took specific anti-seizure medications during pregnancy do not exhibit worse neurodevelopmental results by age 6. The findings were detailed in the journal JAMA Neurology.
“Managing seizures during pregnancy is vital for prenatal care in women with epilepsy. For a long time, the impact of newer anti-epileptic drugs on offspring remained unexplored,” remarked Adam Hartman, M.D., a program director at the NIH’s National Institute of Neurological Disorders and Stroke (NINDS). “This study’s cornerstone was linking children’s cognitive performance to their mothers’ medication levels, allowing for potential advancements in dosing strategies.”
Addressing epilepsy amid pregnancy poses challenges, as several traditional anti-seizure medications, notably valproate, are associated with significant birth complications and cognitive issues such as reduced IQ and autism spectrum disorders. While modern anti-seizure drugs are now widely viewed as secure, their influence on postnatal cognition was not fully understood.
Throughout this research, scientists evaluated the language skills of 387 six-year-old children (298 of whom were born to mothers with epilepsy on medication). The assessments covered various verbal capabilities, such as vocabulary and linking spoken words with images. The investigation revealed no discrepancies in language assessment results between children of medicated and non-medicated mothers. Lamotrigine, levetiracetam, or both, were commonly used by these women throughout and post-pregnancy.
“A child’s assessment at age 6 is significantly more sensitive than at earlier developmental stages like age 2. This age group offers more precise predictions of academic performance and adult cognitive abilities,” stated Kimford Meador, M.D., a study co-leader and neurology professor at Stanford University.
Determining optimal and safe medication doses during pregnancy is also complex, given that risks differ between various anticonvulsants. Previous investigations from this research group highlighted potential negative cognitive effects at age 2-3 and adaptive challenges at around age 4.5 when high doses of levetiracetam were administered, although overall outcomes were favorable for all ages studied.
“It’s crucial to strike a balance in ensuring enough medication is provided to protect both the mother and her unborn child from seizures, without imposing undue risks for the child’s future,” added Dr. Meador.
The research also indicated that folate consumption within the first 12 pregnancy weeks correlates with improved cognitive and behavioral outcomes, even at elevated dosages. Folate, essential for averting neural birth defects, benefits children born to epileptic and non-epileptic mothers alike, with high doses (at or exceeding 4 mg/day) having no detrimental consequences, contradicting earlier studies linking large folic acid doses to long-standing risks.
This investigation is a component of the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study, a forward-looking long-term project examining the impact of anti-seizure medications on pregnant women with epilepsy and their children from birth to age 6. Overseeing this effort were Dr. Meador and Page Pennell, M.D., neurology chair at the University of Pittsburgh, across 20 medical facilities nationwide.
Additional studies indicated no negative outcomes on breastfeeding due to anti-seizure medications. Researchers emphasize the need for more investigations into high folate doses and the emerging epilepsy medicines.
Supported by both the NINDS and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (under grants U01NS038455 and U01NS050659), the study is an essential facet of the MONEAD project (NCT01730170).
The National Institute of Neurological Disorders and Stroke (NINDS), a leading sponsor of neurological studies, seeks to understand and alleviate neurological diseases’ impacts.
As the US government’s primary medical research entity, the NIH, housing 27 institutes and centers, is pivotal in basic, clinical, and translational medical research, striving to unveil causes, therapies, and remedies for common and rare ailments alike.