A recent study has provided reassuring evidence that newer-generation anti-seizure medications, specifically lamotrigine and levetiracetam, do not negatively impact the neurodevelopment of children when taken by their mothers during pregnancy. The findings, published in JAMA Neurology, offer clarity on the safety of these drugs, which are commonly used to manage epilepsy in pregnant women.
The research, part of the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study, tracked the language development of 387 children up to the age of 6. Of these, 298 were born to women with epilepsy who took newer antiseizure medications during pregnancy. The study was funded by the National Institute of Neurological Disorders and Stroke (NINDS).
Verbal Abilities Unaffected
The study assessed children's verbal abilities using standardized tests, including vocabulary and matching spoken words to pictures. The results showed no significant difference in language scores between children exposed to the drugs in the womb and those who were not. This suggests that these newer medications do not impair language development.
"What makes this study meaningful is that when you assess a child at 6, the tests are a lot more sensitive than at earlier ages, especially 2-year-olds," said Dr. Kimford Meador, co-lead investigator of the study and professor of neurology at Stanford University. "There’s measurable impact on school performance and results are more predictive of adult cognitive ability."
Balancing Seizure Control and Fetal Safety
Controlling seizures during pregnancy is crucial for both the mother and the developing fetus. However, older medications like valproate have been linked to birth defects and cognitive issues in offspring, creating a challenge for women with epilepsy. The emergence of newer anti-seizure medications offered a potential solution, but their long-term effects on children's neurodevelopment remained uncertain until now.
"We need to balance making sure there is enough medicine on board to protect the mother and her developing fetus from seizures, but not too much where we're creating risk for the child," explained Dr. Meador.
Impact of Folate Supplementation
The study also found that folate supplementation during the first 12 weeks of pregnancy was associated with better cognitive and behavioral outcomes in children, regardless of whether their mothers had epilepsy. This reinforces the importance of folate intake during early pregnancy, as it can help prevent birth defects and support healthy brain development.
Nuances in Medication Levels
Interestingly, the study revealed some nuances related to medication levels in the mother's blood during the third trimester. Higher doses of lamotrigine appeared to have a positive effect on verbal ability, up to a certain point. Conversely, higher dosages of levetiracetam showed a negative effect on verbal performance. However, the researchers cautioned that these findings should be interpreted with caution, as the study did not randomly assign patients to seizure drugs.
Future Research Directions
While the findings are encouraging, the researchers emphasized the need for further studies to understand the risks associated with less common antiseizure medications and newer drugs on the market. Dr. Meador highlighted the importance of identifying genetic signatures that may make individuals more vulnerable to adverse outcomes from antiseizure medications.
"The next choice is either to use a drug that we know has higher risk or to use a drug where we don’t know the risk," Meador said. "And that’s a pretty bad situation. It is a clear health care disparity."
