The New England Journal of MedicineRisk of Autism after Prenatal Topiramate, Valproate, or Lamotrigine Exposure

Assessing the Neurodevelopmental Outcomes: Antiseizure Medications and Autism Risk

Recent research explores the potential association between maternal use of antiseizure medications during pregnancy and the risk of autism spectrum disorder in children, providing nuanced insights into the effects of specific drugs.

Study Design:

• The study analyzed a population-based cohort of pregnant women and their children in the US from 2000 to 2020.
• Exposure to antiseizure medications was tracked from the 19th gestational week until delivery.
• Children exposed to topiramate during the latter half of pregnancy were compared with those unexposed to any antiseizure medication.
• The study also examined the effects of valproate and lamotrigine, serving as positive and negative controls, respectively.

Key Findings:

• In the general population, the incidence of autism spectrum disorder (ASD) at 8 years was 1.9% among children unexposed to antiseizure medication.
• Among children born to mothers with epilepsy, the ASD incidence was 4.2% without antiseizure medication exposure, 6.2% with topiramate exposure, 10.5% with valproate exposure, and 4.1% with lamotrigine exposure.
• After adjusting for various factors, topiramate and lamotrigine did not show a significant increase in ASD risk compared to no exposure, whereas valproate was associated with a higher risk.

Seizure disorders are the most frequent major neurologic complication in pregnancy, affecting 0.3% to 0.8% of all gestations.

More on Autism Spectrum Disorders (ASD)