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Published on: August 5, 2017
Developmental outcomes at preschool age after fetal exposure to valproic acid and lamotrigine: cognitive, motor,
Tanya Rihtman1, Shula Parush, Asher Ornoy
1School of Occupational Therapy of Hadassah and the Faculty of Medicine, Hebrew University of Jerusalem, Israel. tanya@tanya-branko.com
Insights
Children exposed to anti-epileptic drugs (AEDs) like valproic acid (VPA) and lamotrigine (LT) in utero showed developmental differences. Monitoring these children on broader developmental measures is recommended.
Area of Science:
- Neurodevelopmental disorders
- Pediatric neurology
- Pharmacology
Background:
- Prenatal exposure to anti-epileptic drugs (AEDs) may impact child development.
- Valproic acid (VPA) and lamotrigine (LT) are commonly used AEDs during pregnancy.
- Understanding the long-term developmental effects of in-utero AED exposure is crucial.
Purpose of the Study:
- To assess the neurodevelopmental outcomes of preschool children exposed prenatally to VPA or LT monotherapy.
- To compare developmental trajectories between AED-exposed groups and non-exposed controls.
- To identify specific developmental domains affected by in-utero AED exposure.
Main Methods:
- Prospective, observational study of 124 children aged 3-6 years, 11 months.
- Comparison of children exposed to VPA (n=30) or LT (n=42) in utero versus non-exposed controls (n=52).
- Assessment of cognitive, motor, sensory, executive function, behavioral, and attentional measures.
Main Results:
- Combined AED-exposed children exhibited lower non-verbal IQ, motor, sensory, and parent-reported executive function, behavioral, and attentional scores.
- Separate analyses revealed no cognitive differences between VPA and LT groups, but significant differences in motor and sensory measures compared to controls.
- VPA exposure was associated with parent-reported behavioral and attentional differences compared to controls.
Conclusions:
- In-utero exposure to VPA and LT may be associated with specific neurodevelopmental differences in preschool children.
- Current developmental monitoring may not capture all potential impacts of prenatal AED exposure.
- Expanded developmental surveillance across multiple domains and stages is warranted for children with prenatal AED exposure.
Abstract:
This prospective, observational study assessed the development of preschool children aged 3-6 years, 11 months (n=124) after in-utero anti-epileptic drug (AED) monotherapy exposure to valproic acid (VPA) (n=30, mean age 52.00[±15.22] months) and lamotrigine (LT) (n=42, mean age 50.12[±12.77] months), compared to non-exposed control children (n=52, mean age 59.96[±14.51] months). As a combined group, AED-exposed children showed reduced non-verbal IQ scores, and lower scores on motor measures, sensory measures, and parent-report executive function, behavioral and attentional measures. When the VPA- and LT-exposed groups were analyzed separately, no cognitive differences were found, but control-VPA and control-LT differences emerged for most motor and sensory measures as well as control-VPA parent-report behavioral and attentional differences. No differences were noted between the VPA and LT groups. These findings suggest that VPA- and LT-exposed children should be monitored on a wider range of developmental measures than currently used, and at differing developmental stages.
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