Use of Epilepsy Drug in Pregnancy May Lower Child's IQ

A common epilepsy medication is not safe during pregnancy and could lead to developmental problems in children, an analysis of 28 studies concluded.

The authors of the review, members of the Cochrane Epilepsy Group, specifically call into question the safety of the anti-epileptic drug sodium valproate.

Key Points:

- Women who require anti-epileptic medications should avoid sodium valproate if they intent to become pregnant.

- The drug is linked to developmental delays in children who were exposed to the drug in the womb.

- These delays were sufficient to impact educational and occupational outcomes later in life.

While the reviewers urge additional research to better understand the potential hazards of anti-epileptic drugs on children in the womb, they say that the scientific evidence increasingly suggests there is an affect on development when women take sodium valproate while pregnant.

The meta-analysis focused on children's global cognitive ability using either intelligence quotient (IQ), for school-aged children, or developmental quotient (DQ), for younger children, to provide a summary of development across a range of cognitive skills. For the review, the researchers looked at scores in the children of three groups of pregnant women: those with epilepsy who took anti-epilepsy medication, those with epilepsy who did not take epilepsy medication, and those without epilepsy.

The findings revealed that children born to women who took sodium valproate had lower DQs and IQs than the children of women who didn’t take the drugs either because they had epilepsy and chose not to use their medications or they did not have epilepsy. In addition, higher doses of the drug were linked to large negative effects on both measures.

Researchers also placed the drug carbamazepine under the same microscope but found a different result. While younger children born to women who took carbamazepine had lower DQs, the researchers concluded this effect was due to random variation between the results of the multiple studies. The drug did not appear to affect IQs.

The review is particularly important for women with idiopathic generalized epilepsy, since they are the ones most likely to be prescribed valproate, said Tony Marson, Coordinating Editor Cochrane Epilepsy Group, University of Liverpool.

“Some women may choose to initiate valproate as they have no plans to conceive, while others may choose to avoid valproate and try a less effective drug accepting the associated risk of further seizures,” Marson said.

Some studies included in the analysis also looked at the drugs phenytoin, lamotrigine, levetiracetam, and topiramate, but data were not available on all the drugs used to treat the disorder. There was a particular lack of data among newer medications, causing the authors to suggest future research be conducted in a more timely fashion to better inform women of childbearing age.