Epilepsy Rx During Pregnancy May Put Kids at Risk

Epilepsy medication use in pregnant women tied to later developmental issues in their children

(RxWiki News) Pregnant women face many choices as they prepare for the baby's arrival. And new research suggests that moms-to-be with epilepsy may have an extra decision to make about their medication.

A new review found poorer cognitive development among children whose mothers took medication for epilepsy while pregnant. The review compared these results to those of children born to mothers without epilepsy and children born to mothers with untreated epilepsy.

In epilepsy, abnormal activity in the brain's nerve cells can cause seizures — events that may include loss of consciousness and convulsions. Treatment for the condition often involves antiepileptic medications, like carbamazepine (brand name Tegretol) and sodium valproate (brand name Eliaxim).

"All medications have a pregnancy category that speaks to the relative risk of harm of a particular medication to a developing pregnancy," said Andre Hall, MD, an OB-GYN at Birth and Women's Care, PA in Fayetteville, NC. "Many anti-seizure medications are what's known as a Category D."

Dr. Hall, who was not involved in this study, explained that Category D states that there is evidence that the medication could pose a risk to the developing fetus, but that the potential benefits of the medication may warrant its use during pregnancy despite the risks.

"As a result, many anti-epilepsy drugs are not recommended during pregnancy. In the event that a patient is on one of these medications upon becoming pregnant, the obstetrician works with the neurologist to look for alternatives that are safer but also prevent seizures in the pregnant patient," Dr. Hall told dailyRx News.

"All women considering pregnancy should research the medications they are on in order to know the potential risks to a developing pregnancy," he said.

This recent review was led by Rebecca Bromley, ClinPsyD, PhD, of the Institute of Human Development at the University of Manchester in the United Kingdom.

The study authors found that children whose mothers took antiepileptic medications during pregnancy may have a raised risk of later developmental issues.

To explore the topic, Dr. Bromley and team reviewed 22 studies involving pregnant women on antiepileptic medications and their children. They looked at the children's development with intelligence quotient (IQ) and developmental quotient (DQ) scores.

IQ scores were measured for children old enough to be in school. DQ scores were measured for younger children. These scores measure how people perform tasks compared to the average. IQs and DQs are often used to predict special needs and educational and job performance, with lower scores suggesting problems in these areas.

Dr. Bromley and colleagues found that, among 123 young children exposed to sodium valproate, the average DQ was 8.72 points lower than the scores of 58 children whose mothers had epilepsy but did not take medication while pregnant.

The authors also found that, among 76 older children whose mothers took sodium valproate during pregnancy, the average IQ was 8.94 points lower than that of 552 children born to mothers without epilepsy. The average IQ of 89 children exposed to sodium valproate was also found to be 8.17 points lower than the IQs of 87 children whose mothers had untreated epilepsy.

Children of mothers who took the medication carbamazepine while pregnant did not have lower scores than average.

"The most important finding is the reduction in IQ in the VPA [sodium valproate] exposed group, which are sufficient to affect education and occupational outcomes in later life," Dr. Bromley and team wrote. "However, for some women VPA is the most effective drug at controlling seizures."

The researchers noted that uncontrolled seizures can be dangerous during pregnancy. Women with epilepsy should receive counseling about the potential risks and benefits of antiepileptic medications before treatment begins. Further research is needed to understand more about the issue, including how newer antiepileptic medications might affect unborn children, the study authors noted.

The study was published Oct. 30 in The Cochrane Library.

The National Institute for Health Research, UK, provided funding for the study. Some of the study authors received funding to attend conferences and work on studies funded by a number of pharmaceutical groups, such as UCB Pharma and Pfizer.

Review Date: 
October 29, 2014