No difference in cognitive outcomes in children born to women taking antiseizure medicines

There is no significant difference in cognitive outcomes at two years of age between children of women who took antiseizure medicines during pregnancy and children of women who did not, study results published in JAMA Neurology have suggested (7 June 2021)​[1]​.

During the ‘Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs’ (MONEAD) study, children will be followed from birth to six years of age. This article reports the assessments at the age of two years.

The Bayley Scales of Infant and Toddler Development (third edition) scores were used for five developmental domains: language, motor, cognitive, social-emotional and general adaptive. The primary outcome was the language domain score and its association with the child’s blood levels of antiseizure medicines during the third trimester.

The researchers analysed 292 children who were born to mothers with epilepsy, most of whom were taking either lamotrigine and/or levetiracetam, and 90 children who were born to healthy women. They found no difference between the groups in scores recorded across the five domains. 

Although, secondary analysis revealed that higher maximum observed antiseizure medicines levels in the third trimester were associated with lower scores for the motor (-5.6; 95% confidence interval [CI] -10.7 to -0.5) and general adaptive (-1.4; 95% CI -2.8 to -0.05) domains.

The authors described the primary findings as “encouraging” and said that they may be owing to the use of newer antiseizure medicines that have a “lower risk of affecting the immature brain”.

“However, these findings must be interpreted within the context that neuropsychological assessments conducted at 2 years of age are not as strongly associated with adolescent/adult functioning as assessments performed in older children,” they added.