NEW YORK (Reuters Health) – The school performance at age 16 of children born to epileptic mothers correlates with their degree of exposure to anticonvulsant drugs in utero, according to a Swedish study published online November 4 in Epilepsia.

“However, and this is very important to remember, most children born to women with epilepsy are born healthy and remain healthy,” lead investigator Dr. Lisa Forsberg noted in an email to Reuters Health.

Dr. Forsberg with the Karolinska Institute in Stockholm and colleagues point out there has been a rising concern that exposure to antiepileptic drugs (AEDs) in utero may have permanent effects on cognition, behavior, and academic achievement in exposed children.

In order to assess the latter possibility, the authors studied the school grades of 16-year-old children of mothers with epilepsy. Linking the Swedish Medical Birth Register to the School Mark Registry allowed the team to analyze the academic performance of 1235 such children.

“Among them, there was no mention of use of anticonvulsants in 165 instances (13%). Among the remaining 1,070 children, 641 had been exposed to anticonvulsants in monotherapy and 429 in polytherapy,” the researchers found.

Exposure to two or more anticonvulsants was associated with an increased risk (OR 2.99) for not receiving a final grade on completing compulsory school. “This usually means that the child was not attending general school due to mental retardation,” the authors explain.

Exposure to one AED in utero did not affect the odds of a child receiving a final grade (OR 1.19), but monotherapy was associated with less likelihood of attaining a “pass with excellence,” according to the report.

Dr. Forsberg commented that possible confounders could not be controlled for in the study. “The effect on school results seen in children exposed to polytherapy may be the result of the influence of AEDs during fetal life but it may also be the effect of factors related to epilepsy such as genetic factors, social factors and the effect of the mother’s seizures.” The data should therefore be interpreted with caution, she advised.

Nevertheless, Dr. Forsberg and her colleagues conclude that the results support current recommendations to replace polytherapy with monotherapy for women with epilepsy during pregnancy, if adequate seizure control can be obtained.

“Women with epilepsy are advised to plan their pregnancies,” she added. “This way, the woman and her doctor can come up with an individual treatment plan making the pregnancy as safe as possible for mother and child.”

Reference:

School performance at age 16 in children exposed to antiepileptic drugs in utero—A population-based study

Epilepsia 2010.