Some epilepsy drugs taken during pregnancy may impair brain development

December 19, 2000

Additional educational needs in children born to mothers with epilepsy 2001;70:15-21

Certain epilepsy drugs taken during pregnancy may impair children's normal brain development, suggests research in the Journal of Neurology Neurosurgery and Psychiatry. That research includes the following information and findings. Around one in three people taking anti-epileptics is a woman of reproductive age, and it is estimated that one in 250 pregnancies will be exposed to anti-epileptic drugs.

A retrospective survey was carried out in 1998 of over 1000 women between the ages of 16 and 40 who were registered with the Mersey Regional Epilepsy Clinic. The Clinic is one of the largest epilepsy services in the UK.

Over 700 women responded. Their average age was 23 at the time of the birth, and almost half of them had given birth to just under 600 children between them. Four hundred of the children were of school age. Only 176 of the children had not been exposed to any anti-epileptic drugs whilst in the womb.

Children whose mothers had taken anti-epileptic drugs during pregnancy were 50 per cent more likely to have "additional educational needs" than those were whose mothers had not taken these drugs. These needs referred to "statementing," attendance at special needs schools, or extra help with mainstream schooling.

Those whose mothers had taken valproate alone, a drug prescribed for epilepsy in the UK for 25 years, had a threefold increased risk of additional educational needs. Those whose mothers had taken a combination of drugs, including valproate, had over twice the risk. Carbamazepine taken alone was not associated with an increased risk.

The authors conclude that because of the retrospective nature of the survey, the findings should be treated with caution. And they point out that over 90 per cent of pregnancies in women with epilepsy are not problematic. But they say, there is growing concern over the risks of developmental delay in children whose mothers take drugs for epilepsy. And, they say, valproate may carry particular risks about which prospective mothers need to be informed.

Professor David Chadwick, University Department of Neurology, Walton Centre for Neurology, Liverpool.

BMJ Specialty Journals

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