Journal Article

Antiseizure medication use during pregnancy and children’s neurodevelopmental outcomes

Berglind, Daniel, Lundberg, Michael, Forbes, Harriet, Ahlqvist, Viktor H., Lyall, Kristen, Barry, Ciarrah-Jane S., Magnusson, Cecilia, Lee, Brian K., Madley-Dowd, Paul, Rast, Jessica E., Newschaffer, Craig J., Davies, Neil M., Zhong, Caichen, Martin, Florence Z., Tomson, Torbjörn, Rai, Dheeraj

2024

Overview

The teratogenic potential of valproate in pregnancy is well established; however, evidence regarding the long-term safety of other antiseizure medications (ASMs) during pregnancy remains limited. Using routinely collected primary care data from the UK and nationwide Swedish registries to create a cohort of 3,182,773 children, of which 17,495 were exposed to ASMs in pregnancy, we show that those exposed to valproate were more likely to receive a diagnosis of autism, intellectual disability, and ADHD, when compared to children not exposed to ASMs. Additionally, children exposed to topiramate were 2.5 times more likely to be diagnosed with intellectual disability (95% CI: 1.23–4.98), and those exposed to carbamazepine were 1.25 times more likely to be diagnosed with autism (95% CI: 1.05–1.48) and 1.30 times more likely to be diagnosed with intellectual disability (95% CI: 1.01–1.69). There was little evidence that children exposed to lamotrigine in pregnancy were more likely to receive neurodevelopmental diagnoses. While further research is needed, these findings may support considering safer treatment alternatives well before conception when clinically appropriate. Some antiseizure medications including valporate are associated with neurodevelopmental conditions in children exposed in utero but evidence is less clear for other drugs. Here the authors investigate associations between antiseizure medication use in pregnancy and neurodevelopmental conditions using electronic health record data from the UK and Sweden.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 692/499 / 692/699/375 / 692/700/478/174 / Adolescent / Adult / Anticonvulsants / Anticonvulsants - adverse effects / Anticonvulsants - therapeutic use / Attention Deficit Disorder with Hyperactivity - drug therapy / Attention Deficit Disorder with Hyperactivity - epidemiology / Attention deficit hyperactivity disorder / Autism / Autistic Disorder - chemically induced / Autistic Disorder - drug therapy / Carbamazepine / Carbamazepine - adverse effects / Carbamazepine - therapeutic use / Child / Child, Preschool / Children / Cohort Studies / Electronic health records / Electronic medical records / Epilepsy - drug therapy / Exposure / Female / Humanities and Social Sciences / Humans / Infant / Intellectual disabilities / Intellectual Disability - epidemiology / Lamotrigine / Lamotrigine - adverse effects / Lamotrigine - therapeutic use / Male / multidisciplinary / Neurodevelopmental Disorders - chemically induced / Neurodevelopmental Disorders - epidemiology / Pregnancy / Pregnancy Complications - drug therapy / Prenatal Exposure Delayed Effects - chemically induced / Prenatal Exposure Delayed Effects - epidemiology / Primary care / Registries / Science / Science (multidisciplinary) / Sweden - epidemiology / Teratogenicity / Topiramate / Topiramate - adverse effects / Topiramate - therapeutic use / United Kingdom - epidemiology / Valproic acid / Valproic Acid - adverse effects / Valproic Acid - therapeutic use