If valproate, topiramate and carbamazepine, taken during pregnancy, increase the risk of malformations and neurodevelopmental disorders in the child, lamotrigine and levetiracetam confirm their safety with regard to the risk of neurodevelopmental disorders. A study funded by the National Institutes of Health (NIH) published in the Jama Neurology reinforces the conclusions of the latest report from the National Medicines Safety Agency (ANSM) according to which, for these two new antiepileptics, “the available data do not demonstrate an increased risk of major congenital malformations or neurodevelopmental disorders”.
The American study followed the children of mothers who took anti-epileptic drugs during pregnancy until they were six years old. The authors observed that children born to mothers treated with lamotrigine and/or levetiracetam had neurodevelopmental outcomes at age six comparable to those born to unaffected, untreated mothers.
No difference in language scores
“One of the main components of this study was to correlate children’s cognitive abilities with maternal blood drug levels. This opens the way for future work and could lead to improved dosing strategies,” the authors comment on their work.
The team thus evaluated the language abilities of 387 children at the age of six, 298 of whom were born to epileptic women treated during pregnancy, mainly with lamotrigine, levetiracetam or a combination of the two. The tests do not show any difference in language scores between exposed and unexposed children. For the other anti-epileptic molecules, the numbers were too low for the results to be interpretable.
The authors detail: “At six years old, the tests are much more sensitive than at earlier ages, particularly at two years old. The influence on academic performance is measurable and the results are more predictive of cognitive abilities in adulthood.”
A good dose which varies depending on the molecule
Beyond evaluating drug safety, the authors wanted to address the issue of dosage. “Finding the most effective and safest doses during pregnancy is challenging, and risks tend to vary between anti-seizure medications”they explain. For example, a previous study by the same team showed that high doses of levetiracetam could lead to poorer cognitive outcomes at ages two and three, and poorer adaptive functioning at ages four and a half. , but that the overall results for all ages were positive. For the team, all of these results encourage us to continue anti-epileptic treatment in pregnant women, avoiding doses that are too high for “do not create a risk for the child”.
The authors also analyzed the effect of taking it combined with other treatments on neurodevelopment. Thus, they found that taking paracetamol during pregnancy is correlated with poorer cognitive scores in children. Conversely, taking folate during the first twelve weeks of pregnancy is beneficial with better cognitive and behavioral results, even for high doses (≥ 4 mg), contrary to previous studies reporting a long-term risk. term. These contradictory results make the authors recommend continuing research on high-dose folic acid during pregnancy, but also more widely on other new, less common anti-epileptic drugs.
