Evidence for spared attention to faces in 7-month-old infants after prenatal exposure to antiepileptic drugs

Abstract

a b s t r a c t a r t i c l e i n f oIntroduction: Prenatal antiepileptic drug (AED) exposure is associated with an increased risk of cognitive impairment and autism spectrum disorders detected mainly at the age of two to six years. We examined whether the developmental aberrations associated with prenatal AED exposure could be detected already in infancy and whether effects on visual attention can be observed at this early age. Material and methods: We compared a prospective cohort of infants with in utero exposure to AED (n = 56) with infants without drug exposures (n = 62). The assessments performed at the age of seven months included standardized neurodevelopmental scores (Griffiths Mental Developmental Scale and Hammersmith Infant Neurological Examination) as well as a novel eye-tracking-based test for visual attention and orienting to faces. Background information included prospective collection of AED exposure data, pregnancy outcome, neuropsychological evaluation of the mothers, and information on maternal epilepsy type. Results: Carbamazepine, oxcarbazepine, and valproate, but not lamotrigine or levetiracetam, were associated with impaired early language abilities at the age of seven months. The general speed of visuospatial orienting or attentional bias for faces measured by eye-tracker-based tests did not differ between AED-exposed and control infants. Discussion: Our findings support the idea that prenatal AED exposure may impair verbal abilities, and this effect may be detected already in infancy. In contrast, the early development of attention to faces was spared after in utero AED exposure.

Neurotoxins and Autism

“…In a recent study by Videman et al, carbamazepine, oxcarbazepine, and VPA were associated with impaired early language abilities at the age of 7 months. In contrast, face perception or social attention may be less affected by the neurotoxic effects of the studied AEDs [50]. Previously, the association between prenatal exposure to AEDs and the increased risk of cognitive impairment and ASD was detected at ages of 2 to 6 years.…”

In Utero Oxcarbazepine Exposure and Neonatal Abstinence Syndrome: Case Report and Brief Review of the Literature

“…An infant with micrognatia, low‐set ears, facial dysmorphism, and unilateral radius aplasia due to lamotrigine and oxcarbazepine exposure during pregnancy was reported . A prospective cohort concluded that in utero exposure to oxcarbazepine was associated with impaired early language abilities at the age of 7 months . A cohort study that included 2600 children exposed to antiepileptics during pregnancy and 771,412 unexposed children showed that oxcarbazepine had a low risk of major congenital malformation (1.8% for oxcarbazepine monotherapy, odds ratio 0.64, p=0.66) .…”

“…5 A prospective cohort concluded that in utero exposure to oxcarbazepine was associated with impaired early language abilities at the age of 7 months. 31 A cohort study that included 2600 children exposed to antiepileptics during pregnancy and 771,412 unexposed children showed that oxcarbazepine had a low risk of major congenital malformation (1.8% for oxcarbazepine monotherapy, odds ratio 0.64, p=0.66). 3 Although the use of oxcarbazepine appeared to be relatively safe, further studies are still needed.…”

Advances in Epidemiological Methods and Utilisation of Large Databases: A Methodological Review of Observational Studies on Central Nervous System Drug Use in Pregnancy and Central Nervous System Outcomes in Children

“…Of the 111 studies, forty-six (41%) obtained their data from an administrative database/registry ( 116,117,119,120,123,125), and four (4%) studies did not clearly specify the data source (66,(79)(80)(81). Selection of data sources has changed over time with administrative databases/registries comprising large numbers of participants becoming the most commonly used data source in recent years.…”