A new study from Drexel University’s Dornsife School of Public Health has revealed that children exposed to certain antiseizure medications in utero may face heightened risks of neurodevelopmental conditions, such as autism and intellectual disability. Published in Nature Communications, the research analyzed data from over three million children in the United Kingdom and Sweden, including 17,495 who were exposed to antiseizure medications during pregnancy.

The researchers discovered that, while the overall risk of neurodevelopmental outcomes in children exposed to these medications is modest, the type of medication administered is critical. Lamotrigine, for example, was not related to increased chances of autism or intellectual disability in comparison to unexposed children, indicating that it may be a safer option. However, specific neurodevelopmental issues have been associated with valproate, topiramate, and carbamazepine.

"Our findings suggest that while certain medications may pose some risk, lamotrigine may be a less risky option," said co-author Brian K. Lee, PhD, a Drexel University professor. "Active monitoring of any antiseizure medication is critical to ensure safety and effectiveness, particularly during pregnancy."

The study found that children exposed to topiramate during pregnancy had a 2.5-fold increased risk of intellectual disability diagnosis, which escalated to 2.1% by the age of 12. Despite these findings, experts warn that quitting antiseizure drugs without medical evaluation could have catastrophic repercussions.

"Decisions should be made that are tailored to individual patients," stated co-author Paul Madley-Dowd, PhD, of the University of Bristol. "Stopping antiseizure medications can cause individual harm and harm to offspring, so these conversations always need to happen with a clinician."

Unlike prior research, this study found no statistically significant association between topiramate or levetiracetam and attention deficit hyperactivity disorder (ADHD) in children, regardless of whether the birth parent had epilepsy. The sibling analysis approach helps to decrease biases from genetic or environmental factors, resulting in more robust insights into the effects of these medications.

The study emphasizes the necessity of personalized medical guidance for expectant mothers with epilepsy or psychiatric problems. According to co-author Viktor H. Ahlqvist of Karolinska Institutet, "If you're pregnant or trying to conceive and taking one of these medications, it may be worth talking with your doctor to make sure you're taking the best medicine for your needs while minimising risk to future children."

While the study's huge sample size reinforces its conclusions, the authors stress the importance of more international research to assess the safety of these medications as novel treatments become available.

Researchers from Drexel University, Karolinska Institutet, the University of Bristol, and institutions around the United States, the United Kingdom, and Sweden collaborated on this important study.