Early Child Development and Exposure to Antiepilepsy Drugs Prenatally and through Breastfeeding

In the November early view of the journal JAMA Neurology, Drs. Veiby and colleagues from Norway present an analysis of mothers at 13 to 17 weeks of pregnancy who were recruited in a population-based prospective Norwegian mother and child cohort study from 1999 to 2009.

• The mothers reported on their child’s motor, social skills, language and behavior using items from standardized screening tools at six months for 78,744 subjects; 18 months for 61,351 subjects; and 36 months for 44,147 subjects who had breastfed their child.
• The investigators found that carbamazepine, lamotrigine, and valproate were the most commonly used drugs in monotherapy.
• They found that at six months, 223 infants and mothers using antiepilepsy drugs had a higher risk of impaired fine motor skills compared with a reference group, 11.5% vs. 4.8%, respectively, an odds ratio of 2.1.
• Use of multiple antiepilepsy drugs compared with the reference group is associated with adverse outcomes for both fine motor skills, 25% vs. 4.8%, respectively; an odds ratio of 4.3; and social skills at 22.5% vs. 10.2%, respectively; odds ratio 2.6.
• Continuous breastfeeding in children of women using antiepilepsy drugs was associated with less impaired development at age 6 and 18 months, compared with those with no breastfeeding or breastfeeding for less than six months.
• At 36 months, prenatal antiepilepsy drug exposure was associated with adverse development regardless of breastfeeding status during the first year.
• Children of women with epilepsy who did not use antiepilepsy drugs and children of fathers with epilepsy had normal development at six months.
• The investigators concluded that prenatal exposure to antiepilepsy drugs was associated with impaired fine motor skills at age six months, especially when the child was exposed to multiple drugs. However, there were no harmful effects of breastfeeding.
• Women with epilepsy should be encouraged to breastfeed their children irrespective of antiepilepsy drug treatment.