A team of US scientists has declared two commonly used antiseizure medications -- lamotrigine and levetiracetam -- safe for use during pregnancy. This research, published in JAMA Neurology, is a major advancement in the management of epilepsy, a chronic neurological condition that can cause sudden numbness, body stiffness, shaking, fainting, speech difficulty, and involuntary urination.
The study was conducted by researchers from Stanford University who evaluated the long-term effects of these drugs on children born to mothers who took one or both medications for epilepsy while pregnant. The study involved 298 children of women with epilepsy and a comparison group of 89 children of healthy women. The results confirmed that lamotrigine and levetiracetam offer a safe alternative to older antiseizure medications such as valproate, which are known to raise the risk of autism and lower IQ, as well as impair other cognitive abilities in children.
The team found that verbal ability at age 6 was normal in children whose mothers had used one or both of the drugs during pregnancy. They also found no statistically significant differences in a variety of other cognitive and psychosocial outcomes in 6-year-olds.
Lead author Kimford Meador, Professor of Neurology and neurological sciences, stated, "For these newer drugs, lamotrigine, and levetiracetam, the outcomes look very good. We didn't see any difference in outcomes between the children of women with epilepsy who took the newer medications and the children of healthy women, which is very encouraging."
The study underscores the importance of preventing as many seizures as possible during pregnancy, as seizures can harm both the mother and the foetus. Women with epilepsy need care from neurologists and obstetricians who are skilled in managing the disease during pregnancy. With the right care, Meador added, "Well over 90 per cent of women with epilepsy will have normal pregnancies and normal children."
This research is supported by grants from the National Institute of Neurological Disorders and Stroke. It is a significant contribution to the understanding of the safety of antiseizure medications during pregnancy, providing reassurance to women with epilepsy who are pregnant or planning to become pregnant.
In addition to this, the children also completed standard tests of other neurological and psychological abilities, including general intelligence, visuospatial ability, memory, executive function, motor skills, processing speed, and behavior. Folate early in pregnancy was found to be helpful. Women are typically told to take folate supplements in early pregnancy to prevent major structural birth defects such as spina bifida, but new findings, including from this study, are also showing that folate supplementation has other benefits for children of women with epilepsy.
The research also highlighted a clear health care disparity. "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."
This study is a significant step forward in understanding the safety of antiseizure medications during pregnancy and provides reassurance to women with epilepsy who are pregnant or planning to become pregnant. It also underscores the importance of preventing as many seizures as possible during pregnancy, as seizures can harm both the mother and the foetus. Women with epilepsy need care from neurologists and obstetricians who are skilled in managing the disease during pregnancy. With the right care, well over 90 per cent of women with epilepsy will have normal pregnancies and normal children.
