THURSDAY, Nov. 4 (HealthDay News) -- Teens born to women who
took two or more epilepsy drugs while pregnant fared worse in
school than peers with no prenatal exposure to those medications, a
large Swedish study has found.
Also, teens born to epileptic mothers in general tended to score
lower in several subjects, including math and English.
The findings support earlier research that linked prenatal
exposure to epilepsy drugs, particularly valproic acid (brand names
include Depakene and Depakote), to negative effects on a child's
ability to process information, solve problems and make
"Our results suggest that exposure to several anti-epileptic drugs in utero may have a negative effect on a child's
neurodevelopment," said study author Dr. Lisa Forsberg of
Karolinska University Hospital.
The study was published online Nov. 4 in
The study was retrospective, meaning that it looked backwards in
time. Using national medical records and a study conducted by a
local hospital, Forsberg and her team identified women with
epilepsy who gave birth between 1973 and 1986, as well as those who
used anti-epileptic drugs during pregnancy. The team then obtained
records of children's school performance from a registry that
provides grades for all students leaving school at 16, the age that
mandatory education ends in Sweden.
The researchers identified 1,235 children born to epileptic
mothers. Of those, 641 children were exposed to one anti-epileptic
drug and 429 to two or more; 165 children had no known exposure to
The researchers then compared those children's school
performance to that of all other children born in Sweden (more than
1.3 million) during that 13-year period.
The teens exposed to more than one anti-epileptic drug in the
womb were less likely to get a final grade than those in the
general population, said Forsberg. Not receiving a final grade
generally means not attending general school because of mental
deficits, she explained.
While teens exposed to only one anti-seizure medication did not
show the same risk, they were less likely to pass with excellence.
This may be the result of the influence of the anti-epileptic drug
during fetal life, but it may also be the effect of factors related
to epilepsy, such as genetic factors, social factors and the effect
of the mother's seizures, said Forsberg. "Therefore, these data
should be interpreted with caution."
Anti-epileptic medications besides valproic acid include
phenytoin (such as Dilantin and Phenytek) and carbamazepine (such
as Tegretol and Carbatrol). The study noted that compared to other
anti-epileptic drugs, valproic acid during pregnancy seems to have
a stronger negative influence on cognitive skills. However,
Forsberg said that this study could not draw specific conclusions
about valproic acid, since very few of the children studied were
exposed to it.
There's also evidence that taking multiple anti-epileptic drugs
can cause more harm than taking just one. That's why the American
Academy of Neurology recommends taking just one during pregnancy,
if possible, and trying medications other than valproic acid.
Dr. Jacqueline A. French, professor of neurology at NYU Langone
Medical Center and director of the Clinical Trials Consortium at
the NYU Comprehensive Epilepsy Center, said that the retrospective
nature of the study made it difficult to control for unknowns that
could have affected its findings. For example, the study could not
factor in how often the mothers had seizures during their
pregnancies or during critical early years of the child's life.
"I think that could have an impact on the child's development," said French. "We can't exclude the possibility that a woman on anti-epileptic drugs whose seizures are well controlled has just as much likelihood of having a child that excels as a woman who is not on the drugs."
Forsberg agreed, noting that most children exposed to
anti-epileptic drugs do complete school, and that most children of
epileptic mothers are born and remain healthy.
However, the study findings support current recommendations that
pregnant women take just one anti-epileptic drug if possible, noted
Forsberg. She also recommended that women with epilepsy plan their
pregnancies. "That way, they and their doctors can come up with
individual treatment plans that make the pregnancy safe for both
mother and child," she said.
To learn more about women and epilepsy, visit the
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