How to Manage the Risks Associated With Epilepsy and Pregnancy

Cognitive Defects

In the NEAD study, the mean IQ of 3-year-olds who had been exposed in utero to valproate was 9 points lower than that of children exposed in utero to lamotrigine, 7 points lower than that of children exposed in utero to phenytoin, and 6 points lower than that of children exposed in utero to carbamazepine. The association between valproate exposure and IQ was dose-dependent. “Verbal abilities were lower for valproate, compared with the other three drugs,” Dr. Meador said. “Children exposed to lamotrigine had better nonverbal abilities than those exposed to valproate, and the other two drugs had a trend in the same direction.”

At age 6, the same children who had been exposed to valproate did poorly on measures of verbal and memory abilities, compared with children exposed to the other AEDs, and on nonverbal and executive functions, compared with children exposed to lamotrigine (but not compared with children exposed to carbamazepine or phenytoin). High doses of valproate were negatively associated with IQ, verbal abilities, nonverbal abilities, memory, and executive function, but other AEDs were not. IQ at age 6 correlated with IQ at younger ages, and IQ improved with age for infants exposed to any AED.

Breastfeeding

Research has established that breastfeeding is beneficial for mother and child. “A concern has been raised that there is a risk that exposure to AEDs in breast milk might cause damage to the baby,” Dr. Meador remarked. To analyze that possibility, he and his colleagues examined data for the 42.9% of study children who were breastfed for a mean of 7.2 months. There were no differences in breastfeeding rates and duration between drugs. Although more study is needed to fully delineate the effects of all AEDs, the adjusted IQ was 4 points higher at age 6 for breastfed children than for children who were not breastfed, and verbal abilities were greater, as well.

—Adriene Marshall