Cognitive Development in Children Exposed to Levetiracetam (Keppra)

An increasing number of reproductive age women now take newer anticonvulsants for the treatment of mood and anxiety disorders; however, information regarding the reproductive safety of these medications is limited.  A recent study has evaluated the cognitive and language development of children born to women with epilepsy exposed in utero to levetiracetam (LEV, Keppra) or sodium valproate (VPA, Depakote), as compared to control children born to women without epilepsy not taking medication during pregnancy.

Levetiracetam (Keppra) and Pregnancy

While it is well-established that several of the older anticonvulsants, including valproate (Depakote), carry a significant teratogenic risk, less is known about the reproductive safety of the newer antiepileptic drugs (AEDs).  A new report from the U.K. and Ireland Epilepsy and Pregnancy Registers suggests that the risk of malformations associated with levetiracetam (LVT, Keppra) use during pregnancy is low.

Prenatal Exposure Antiepileptic Drugs Associated with Worse Developmental Outcomes

We have previously written about studies which indicate that prenatal exposure to antiepileptic drugs (AEDs), particularly valproic acid, may adversely affect the developing fetus.  Numerous studies have documented long-term effects of antiepileptic exposure on cognitive functioning: prenatal exposure to AEDs has been associated with lower IQs, as well as lower scores on tests of executive functioning, memory, verbal and nonverbal abilities, in children at 6 yeas of age (Meador KJ et al, 2012).  These deficits were the most prominent in children exposed to valproic acid.

Gabapentin (Neurontin) and Pregnancy

Despite the fact that gabapentin (Neurontin) is now used in a wide variety of clinical settings -- for epilepsy, pain management, anxiety, sleep disturbance – there is relatively little information regarding its reproductive safety.  A prospective study from researchers at the Motherisk program reports on the outcomes of 223 pregnancies exposed to gabapentin and 223 unexposed pregnancies.

Exposure to Valproic Acid and Increased Risk of Autism Spectrum Disorders

There have long been concerns regarding the use of the anticonvulsant valproate (Depakote, VPA) during pregnancy. First trimester use of valproate has been associated with a 3-5% risk of neural tube defects, as well as an increased risk of other malformations affecting the heart and other organ systems.  Multiple reports have also indicated that in utero exposure to valproate may also negatively affect cognitive development.

What’s Worse for Pregnancy: Bipolar Disorder or the Medications Used to Treat It?

In studies of pregnant women with unipolar depression, it has been shown that untreated psychiatric illness in the mother may have a negative impact on pregnancy outcomes, influencing the length of gestation and birthweight.  There is far less data on pregnancy outcomes in women with bipolar disorder.  A recent Swedish study analyzes pregnancy outcomes in treated and untreated women with bipolar disorder and attempts to distinguish between the effects of medication versus the effects of untreated psychiatric illness in the mother.