This is one in an occasional series about children’s health issues. We know that many of our readers are grandparents keenly interested in the health and well-being of grandchildren. We hope this series will provide readers useful health information they can share with their families.
Pregnancy is a time of heightened concern for women with epilepsy, especially regarding the effect seizure medication may have on unborn children. A new study from Royal Manchester Children’s Hospital in England provides some reassurance about two drugs, at least relative to children’s cognitive development, but reinforces concerns about the third anti-seizure medication.
In 2016, 171 mothers who had given birth between 2004 and 2007 were enrolled in the study, and the cognitive abilities of their then-school-age children analyzed in what is called a “retrospective review.”
We spoke about the study with Dr. Kristy Crawford, D.O., who recently joined IRMC’s Partners in Women’s Health practice. She says the only way such a study will ever be conducted is retrospectively, as a true clinical trial will never be conducted on pregnant women. She adds that the newer anti-epileptic drugs have a better safety profile, with fewer side effects.
Indeed, in a report published online in the journal Neurology, the British researchers concluded there is no link between cognitive abilities in school-age children and two specific epileptic drugs taken in pregnancy – levetiracetam (brand name Keppra) and topiramate (Topamax) – this as compared to children born to mothers who are not taking any anti-epileptic drugs.
Concerns remain, however, about valproate (Depacon), an “older” anti-epileptic drug approved by the FDA in 1996. The team from England found kids exposed to increasing doses of valproate in utero had significantly lower performance on cognitive ability testing than those exposed to similar doses of levetiracetam or topiramate.
The researchers found that as the children reached middle-school age, their exposure while in utero to levetiracetam and topiramate did not negatively impact IQ, verbal or nonverbal abilities, or “processing speed,” defined as the pace at which kids take in information, make sense of it, and begin to respond. In contrast, prenatal exposure to increasing levels of valproate did have a negative effect on those cognitive measurements.
Rebecca Bromley, Ph.D., a member of the Royal Manchester team, says that a better understanding of the use of anti-epileptic drugs in pregnancy and the child’s subsequent neurodevelopment requires additional research. She says “we need more data to comprehensively understand any potential effects these medications may have on fetal development.”
While it’s natural for women with epilepsy to worry during pregnancy, the overwhelming majority have healthy babies. Here are some general points about pregnancy and epilepsy, courtesy of the Epilepsy Foundation:
- Planned pregnancies are best for women with epilepsy. This gives you time to work with your neurology and obstetrical teams in advance of conception, including a review of your seizure medications. It’s important that your teams work together on your – and your baby’s – behalf.
- Plan for frequent visits to your neurology team during pregnancy. Levels of seizure medications will need to be monitored regularly and changes in doses may be needed. Dr. Crawford says “a dose that worked pre-pregnancy may not work in pregnancy, due to changes in how the kidney excrete waste.”
- Make sure you are taking prenatal vitamins. And don’t forget folic acid! Dr. Crawford says “every woman should take folic acid, as it’s designed to prevent birth defects of the brain and spine. Anti-seizure medication can cause a folate deficiency, so women with epilepsy may need a higher-than-typical dose.”
- Pay attention to healthy living and those things that can “trigger” seizures. Some women are more likely to have seizures during pregnancy due to hormonal changes or fluctuating medicine levels.
We asked Dr. Crawford if women with epilepsy should avoid taking any anti-seizure medications during pregnancy. She says, “If a woman has a seizure while pregnant, it can cause damage or death to the baby. We follow the best practice of giving the lowest dose of medicine to get the desired result.” She adds that sometimes two anti-seizure medications are given to those with epilepsy; this should be avoided in pregnant women. She adds that doctors should discuss the risks and benefits of all treatments with their patients.
Dr. Crawford is a board-certified Obstetrician and Gynecologist, and is currently accepting new patients. IRMC’s Partners in Women’s Health office is located at 1050 37thPlace, Suite 101, in Vero Beach. The phone number is 772-790-6116.
