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Cited by 105Pharmacological Effects and Toxicity StudiesPrenatal Substance Exposure EffectsEpilepsy research and treatment

The DOI matches its Crossref record; 23 of the 23 references it cites were found in a registry or an index.

Long-Term Developmental Outcome of Children of Women with Epilepsy, Unexposed or Exposed Prenatally to Antiepileptic Drugs: A Meta-Analysis of Cohort Studies

Banach, Ryan, Boskovic, Radinka, Einarson, Thomas, Koren, Gideon·2010·Drug Safety
DOI 10.2165/11317640-000000000-00000
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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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Crossref · 10.2165/11317640-000000000-00000

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Research works printed but not linked: 1

  1. Koren, 2006, Can Fam Physicians, 52, 441

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Metadata

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
ORCID
Venue
Drug Safety
Publisher
Springer Science and Business Media LLC
Published
2010-01
Volume
33
Issue
1
Pages
73-79
ISSN
0114-5916 (ISSN-L)
DOI
10.2165/11317640-000000000-00000
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 › Clinical Neurology › 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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