In Utero AED ExposureThe Journal of Neurology, Neurosurgery and Psychiatry recently published the findings of Dr. David Chadwick and clinicians at the Department of Neurology, Walton Centre for Neurology, Liverpool University and the Mersey Regional Epilepsy Clinic (one of the UK's largest epilepsy clinics) which indicate that normal brain development may be impaired by exposure to antiepileptic drugs (AEDs) before birth.The study assesses potential additional educational needs of children exposed in utero to AED mono- and poly-therapy. In a retrospective survey, 721 women, 16 to 40 years of age and registered at the clinic, answered questions about their pregnancies and their childrens' school performance. The participants averaged 23 years of age at the time of delivery. Of almost 600 children, 150 were exposed in utero to AED monotherapy, and 74 to polytherapy.
Researchers found that children exposed to AEDs in utero were 50% more likely to have additional special educational needs. Those exposed to polytherapy had twice the risk. Those exposed to valproate had a threefold increased risk of needing education help. No increased risk with exposure to carbamazepine monotherapy was seen.
The study notes the conflict of potential risks to the foetus between a mother's uncontrolled seizures during pregnancy and foetal AED exposure, which may include an increased risk of stillbirths, perinatal mortality, and intrauterine growth retardation, as well as an increase in the number of major and minor birth anomalies. (Neural tube defects have been associated specifically with valproate and carbamazepine.) It also acknowledges the relative contribution of the mother's epilepsy itself, seizure frequency during pregnancy, socioeconomic factors, and teratogenicity of AEDs.
A large study of children and their mothers with epilepsy is continuing, to quantify and characterize their formal cognitive abilities and to investigate the contribution of maternal IQ, seizure experience during pregnancy, and type of epilepsy to the educational outcome of the children.
The clinicians advise that their findings need to be treated with caution and "demand further urgent investigation to clarify and optimize treatment for women with epilepsy who are of childbearing age". They point to the need for controlled studies to quantify risks associated with individual AEDs, including the newer compounds, to ensure that women with epilepsy are adequately advised about the safety of new AEDs.
More Information
http://jnnp.bmjjournals.com/cgi/content/abstract/70/1/15
Teratogenic = tending to produce in utero anomalies or defects in offspring.
from the Greek teras (monster) + genesis (production)
About 1 in 3 persons taking AEDs are women of reproductive age.
It is estimated that 1 in 250 pregnancies will be exposed to AEDs.
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