Long-Term Developmental Outcome of Children of Women with Epilepsy, Unexposed or Exposed Prenatally to Antiepileptic Drugs: A Meta-Analysis of Cohort Studies
Abstract
Results of studies investigating the long-term effects of intra-uterine exposure to antiepileptic drugs (AEDs) on cognitive functioning are limited and conflicting. To estimate intellectual development of children prenatally exposed or unexposed to AEDs by assessing IQ scores in a systematic review and meta-analysis. A literature search using Pubmed, EMBASE and Google Scholar from inception to 30 April 2009 was performed to identify all original cohort studies that investigated cognitive functioning after in utero exposure to AEDs. Studies had to include at least one group exposed to an AED and one unexposed group. Data from drug exposed and unexposed controls were combined using a random effects model. Eleven studies met the inclusion criteria. Eight studies (three for valproic acid and five for carbamazepine) evaluated IQ as a measure of cognitive development. IQ was assessed by the Wechsler, Bayley or McCarthy intelligence scales, depending on age. One study investigated phenytoin and one study investigated phenobarbital (phenobarbitone). Because one study was reported in two different publications, seven studies were included in the meta-analysis. In total, the seven selected studies included 67 children exposed in utero to valproic acid and 151 exposed to carbamazepine, and 494 unexposed controls born to healthy women or to women with untreated epilepsy. The mean full-scale IQ (FSIQ), verbal IQ (VIQ) and performance IQ (PIQ) scores in children exposed to valproic acid in utero were 83.9 (95% CI 64.2, 103.6), 93.7 (95% CI 72.6, 114.7) and 88.3 (95% CI 69.9, 106.9), respectively. The mean FSIQ, VIQ and PIQ scores in the control group were 102 (95% CI 90, 116), 101 (95% CI 87, 114) and 99 (95% CI 90, 117), respectively. The mean FSIQ, VIQ and PIQ were all significantly lower in the valproic acid group compared with the unexposed group. The FSIQ and VIQ of children exposed to carbamazepine were not statistically different from those of the unexposed control group. In a sub-analysis of carbamazepine exposure in three studies using the Wechsler intelligence scale, PIQ was significantly lower in children exposed to carbamazepine than in unexposed children. Although our analysis revealed no evidence that untreated maternal epilepsy was associated with a lower IQ in the child, there may have been confounding factors, such as milder epilepsy, in this group. Exposure to valproic acid in pregnancy is associated with significantly reduced intelligence in children whose mothers were treated for epilepsy. Exposure to carbamazepine in pregnancy does not appear to be associated with reduced FSIQ and VIQ in children, although PIQ was lower in the sub-analysis. Clinicians should inform families of the potential cognitive adverse effects of valproic acid. More studies are needed to corroborate these findings.
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No significant associations were found between neurodevelopment and exposure to other AEDs such as carbamazepine, lamotrigine or phenytoin.
“No significant associations were found between neurodevelopment and exposure to other AEDs such as carbamazepine, lamotrigine or phenytoin.5–8”
Exposure to valproate in utero is linked to significantly lower IQ scores and poorer overall neurodevelopmental outcomes in children.
“Two systematic reviews examined the association between AED exposure and neurodevelopment in utero and reported that exposure to valproate was linked to significantly lower IQ scores and poorer overall neurodevelopmental outcomes in the children of women who used these medications.5 6”
Two previous systematic reviews that did not conduct an NMA found valproate was associated with significantly lower IQ scores and poorer overall neurodevelopmental outcomes compared with an unexposed control group.
“Similarly, two previous systematic reviews that did not conduct an NMA found valproate was associated with significantly lower IQ scores and poorer overall neurodevelopmental outcomes compared with an unexposed control group.5 6”
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Adolescents with Medical Illness
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EEG changes in children born to epileptic parents
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ANTI-EPILEPTIC DRUGS AND BRAIN AND BEHAVIOURAL DEVELOPMENT IN ANIMAL MODELS AND HUMANS
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- Authors
- Banach, R., Boskovic, R., Einarson, T., & Koren, G.
- Affiliations
- McMaster University (CA)
- Hospital for Sick Children (CA)
- University of Toronto (CA)
- Corresponding author
- Koren, Gideon
- Venue
- Drug Safety
- Published
- 2010-01
- Volume
- 33
- Issue
- 1
- Pages
- 73-79
- ISSN
- 0114-5916 (ISSN-L)
- OpenAlex
- W2040225343
- Cited by
- 105
- References
- 23
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 1 · 2022: 7 · 2021: 2 · 2020: 4 · 2019: 9 · 2018: 6 · 2017: 5 · 2016: 7 · 2015: 8 · 2014: 9 · 2013: 16 · 2012: 10
- FWCI
- 6.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drug Safety (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Keywords
- maternal epilepsy, intellectual disability, IQ, valproic acid, carbamazepine, phenytoin, phenobarbital, cognitive development, developmental outcomes, prenatal drug exposure
- MeSH terms
- Anticonvulsants, Cognition Disorders, Epilepsy, Female, Humans, Intelligence, Intelligence Tests, Maternal-Fetal Exchange, Pregnancy, Pregnancy Complications, Prenatal Exposure Delayed Effects, Cohort Studies
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