Abstract: The teratogenic potential of valproate in pregnancy is well established; however, evidence regarding the long-term safety of other antiseizure medications (ASMs) during pregnancy remains limited. Using routinely collected primary care data from the UK and nationwide Swedish registries to create a cohort of 3,182,773 children, of which 17,495 were exposed to ASMs in pregnancy, we show that those exposed to valproate were more likely to receive a diagnosis of autism, intellectual disability, and ADHD, when compared to children not exposed to ASMs. Additionally, children exposed to topiramate were 2.5 times more likely to be diagnosed with intellectual disability (95% CI: 1.23-4.98), and those exposed to carbamazepine were 1.25 times more likely to be diagnosed with autism (95% CI: 1.05-1.48) and 1.30 times more likely to be diagnosed with intellectual disability (95% CI: 1.01-1.69). There was little evidence that children exposed to lamotrigine in pregnancy were more likely to receive neurodevelopmental diagnoses. While further research is needed, these findings may support considering safer treatment alternatives well before conception when clinically appropriate.
Competing Interests: Competing interests T.T. has received support to the EURAP pregnancy registry from Accord, Eisai, GSK, UCB, Bial, Sanofi, GW Pharma, Teva, Angelini Pharma, Zentiva, SF Group, Glenmark and personal fees from Eisai, Sanofi, UCB and Angelini Pharma outside the submitted work. BL reports receiving consulting fees from Beasley Allen Law Firm, Patterson Belknap Webb & Tyler LLP and AlphaSights. None of the above entities had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The remaining authors have no conflicts of interest.
(© 2024. The Author(s).)
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