ANTI-SEIZURE MEDICATION EXPOSURE IN PREGNANCY DOESN’T HARM CHILD’S COGNITIVE OUTCOMES

Featuring: Elizabeth E. Gerard, MD

Children born to women with epilepsy who took anti-seizure medications during pregnancy versus those born to women without epilepsy had similar cognitive outcomes and overall neurodevelopment, according to findings published in JAMA Neurology.

Elizabeth Gerard, MD, associate professor in The Ken and Ruth Davee Department of Neurology’s Division of Epilepsy and Clinical Neurophysiology, was a co-author of the study.

“Compared to most other drugs, anti-seizure medications have been well-studied in pregnancy for the past two decades. However, there is still much we have to learn,” Gerard said.

For the study, Gerard and colleagues enrolled pregnant women with epilepsy and pregnant women without epilepsy at 20 different U.S. epilepsy centers — including Northwestern’s Women’s Epilepsy Program, which is led by Gerard.

The investigators evaluated the women and their children throughout pregnancy, once each trimester. The women were followed through nine months postpartum, and their children are being followed until they turn six years old. When the children were two years old, they were evaluated by a neuropsychologist and using scores collected from the Bayley Scales of Infant and Toddler Development, Third Edition assessment, which evaluates a child’s developmental functioning.

“It’s important to have large cohorts of patients who were exposed to anti-seizure medications and have children that you can follow in a prospective way, because this allows for an unbiased selection of participants and real-time assessments of how they are doing,” Gerard said.

Overall, the investigators found no significant difference in cognitive outcomes among two-year-old children born to women with epilepsy compared women without epilepsy. A secondary analysis, however, revealed indications that higher anti-seizure medication dosage during the third trimester of pregnancy may be associated with lower scores for adaptive and motor skills. This finding requires further investigation, according to the authors.

As for next steps, children have or will be seen by a neuropsychologist at 3, 4.5 and 6-years-old. These data are expected to help clarify the long-term cognitive effects of anti-seizure medication exposure, according to Gerard.

“It’s very hard to do a very in-depth neuropsychological evaluation at age two, so the neuropsychic evaluations get more complex over time and more in depth so we get a better understanding of who the child is and how they’re performing,” Gerard said.

The current study is one of many to stem from the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study, which has published key papers on prescription patterns in pregnant women with epilepsy, as well as fetal death and malformation rates and levels of anti-seizure medications in breastmilk. The MONEAD study also led to research co-authored by Gerard showing that seizure frequency was not higher during pregnancy compared to the postpartum period.

This work was supported by grants U01-NS038455, U01-NS050659 and 2U01-NS038455 from the National Institute of Neurological Disorders and Stroke and the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.

This article was originally published in the Feinberg School of Medicine News Center on July 16, 2021.

Elizabeth E. Gerard, MD, associate professor in The Ken and Ruth Davee Department of Neurology’s Division of Epilepsy and Clinical Neurophysiology, was a co-author of the study published in JAMA Neurology.