Balancing Pregnancy and Epilepsy

Epilepsy medications during pregnancy affected children differently depending on type

(RxWiki News) Women with epilepsy usually need to take medications to treat the condition even while they are pregnant. But how do those medications affect their developing babies?

A recent study found that one epilepsy medication appeared to affect children's development less than another when the children were preschoolers.

The two medications studied were levetiracetam (brand name Keppra) and valproate sodium (brand name Depacon, Depakene or Depakote).

Children whose mothers took levetiracetam during pregnancy scored similarly to children not exposed to medications in the womb.

Children whose mothers took valproate sodium scored lower with motor skills and language skills.

"Ask your neurologist about epilepsy medications during pregnancy."

This study, led by R. Shallcross, PhD, of the Department of Clinical Psychology at the University of Liverpool in the United Kingdom, looked at the development of children whose mothers took epilepsy medications while pregnant.

The researchers compared the children of 97 women who took either levetiracetam or valproate sodium while pregnant to the children of 131 women without epilepsy, who took no prescription medications during pregnancy.

The children were aged 3 to 4.5, and their cognitive skills and language development were tested with established scales.

After taking into account other characteristics that differed among the children and/or their mothers, the 53 children whose mothers took levetiracetam did not score any differently than children not exposed to medications during pregnancy.

Differences were seen, however, among the children whose mothers took valproate sodium during pregnancy.

The 44 children exposed to valproate sodium in the womb scored an average 15.8 points lower on gross motor skills than children exposed to levetiracetam in the womb.

The scale used is calculated similarly to an IQ scale, with 100 representing the average for children.

Children of mothers who took valproate sodium also scored an average 6.4 points lower on language comprehension and 9.5 points lower on expressive language skills, compared to children of mothers who took levetiracetam during pregnancy.

The researchers therefore concluded that children whose mothers used levetiracetam to treat their epilepsy during pregnancy fared better in motor skills and language development than children whose mothers used valproate sodium.

However, the researchers cautioned that their findings do not mean that valproate sodium should never be used during pregnancy.

Because this medication is used to treat seizures, which can also be dangerous for an unborn baby, some women may still need to take it while pregnant.

Andre Hall, MD, an OBGYN at Birth and Women's Care, PA in Fayetteville, NC, said that anti-seizure medications have historically been associated with birth defects.

"This would often create the difficult dilemma of risking birth defects on medication in order to prevent seizures, or assume the risk of seizures to mom and baby in order to avoid the medication-related side effects," Dr. Hall said.

"Fortunately, with the advances in medications, we can now limit or avoid seizures during pregnancy while significantly avoiding adverse effects of the medicines used to treat this disorder," he said. "All women who are pregnant or who are contemplating pregnancy and have a seizure history should discuss the various options with their obstetrician and neurologist."

This study was published January 8 in the journal Neurology.

The research was funded by UCB Pharma Ltd., the Epilepsy Research Foundtion, GlaxoSmithKline, Sanofi Aventis, Janssen-Cilag, Novartis, Pfizer, Eisai and Epilepsy Research UK.

Five authors have received travel funds or advisory board honorariums from various pharmaceutical companies, including Sanofi Aventis and UCB Pharma Ltd.

Three of these authors have also given expert testimony in legal cases related to fetal anticonvulsant syndrome or the safety of anticonvulsants during pregnancy.

Review Date: 
January 8, 2014