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Prenatal Exposure to Antiseizure Medications May Increase Risk of Autism and Intellectual Disability
Prenatal exposure to antiseizure medications, frequently prescribed to pregnant women with epilepsy, increased a child’s risk of neurodevelopmental disorder, including autism spectrum disorder (ASD) and intellectual disability (ID), by 2- to 4-fold, according to a recent study published in JAMA Neurology.
“Women of reproductive age who are prescribed topiramate should be informed of the potential risks, and these should be weighed against the benefits and available treatment options,” Marte-Helene Bjørk, MD, PhD, and co-authors wrote in the study. “Women with epilepsy frequently require antiseizure medication (ASM) during pregnancy, and precise knowledge is needed about the safety for the exposed child.”
The Nordic register-based study of antiepileptic drugs in pregnancy (SCAN-AED) is a population-based cohort study that utilized health and social register data from Denmark, Finland, Iceland, Norway, and Sweden collected from 1996-2017. The cohort included nearly 4.5 million children, including 21,634 unexposed children born to mothers with epilepsy, and 24,825 exposed children, 16,170 of whom were born to mothers with epilepsy.
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Researchers found that the most “robust and dose-dependent associations” between ASM exposure and risk for neurodevelopment disorder were associated with prenatal topiramate and valproate. Among unexposed children, 1.5% developed ASD, and 0.8% developed ID over an 8-year period. In children exposed to topiramate, 4.3% developed ASD and 3.1% developed ID, while in those exposed to valproate, it was 2.7% and 2.4%, respectively. Precise risk varied based upon dosage and trimester during which exposure occurred.
“With regulatory warnings cautioning against valproate use in women of childbearing potential, safety data are urgently needed for alternative treatment options. Similar to valproate, topiramate is indicated for focal and generalized seizures and migraine prevention…However, our results do not suggest that topiramate is a safe alternative to valproate,” the authors concluded.
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