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Prenatal exposure to antiseizure medications (ASMs) is linked to a higher risk of neurodevelopmental disorders (NDDs) in children. This association highlights the need for careful consideration of ASM use during pregnancy.

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Area of Science:

  • Neuroscience
  • Developmental Pediatrics
  • Pharmacology

Background:

  • Antiseizure medication (ASM) use during pregnancy has risen, yet its impact on offspring neurodevelopment remains debated.
  • Existing evidence on prenatal ASM exposure and neurodevelopmental disorders (NDDs) is inconsistent.
  • This study addresses the need for clearer data on the association between prenatal ASM exposure and NDDs.

Purpose of the Study:

  • To evaluate the association between prenatal exposure to antiseizure medications (ASMs) and the risk of neurodevelopmental disorders (NDDs) in children.
  • To analyze data from large, population-based mother-child cohorts in Canada and the United States.
  • To provide evidence for informed decision-making regarding ASM use in pregnant individuals.

Main Methods:

  • Analysis of 5 population-based cohorts (Canadian Mother-Child Cohort [CAMCCO] and AM-PREGNANT).
  • ASM exposure defined by maternal prescription fills within 60 days before birth.
  • NDDs identified using validated algorithms based on ICD-9/10 codes; Cox proportional hazards models and meta-analysis were employed.

Main Results:

  • Prenatal ASM exposure in 0.47% of 2,910,206 children was associated with a 29% increased risk of NDDs (pooled-adjusted hazard ratio [p-aHR]: 1.29).
  • Specific ASMs showed varied risks: carbamazepine (p-aHR: 1.50), clonazepam (p-aHR: 1.22), topiramate (p-aHR: 1.56), and valproic acid (p-aHR: 1.38).
  • Polytherapy showed a trend towards higher risk than monotherapy, but this was not statistically significant.

Conclusions:

  • Prenatal exposure to certain ASMs is consistently linked to elevated risks of NDDs in offspring.
  • Findings underscore the importance of individualized risk-benefit assessments for ASM use during pregnancy.
  • Careful decision-making is crucial to mitigate potential neurodevelopmental risks in children exposed to ASMs prenatally.