Neurodevelopment of babies born to mothers with epilepsy: A prospective observational cohort study

Objective: Despite widespread monotherapy use of lamotrigine or levetiracetam during pregnancy, prospectively collected, blinded child development data are still limited. The NaME (Neurodevelopment of Babies Born to Mothers With Epilepsy) Study prospectively recruited a new cohort of women with epilepsy and their offspring for longitudinal follow-up. Methods: Pregnant women of <21 weeks gestation (n = 401) were recruited from 21 hospitals in the UK. Data collection occurred during pregnancy (recruitment, trimester 3) and at 12 and 24 months of age. The primary outcome was blinded assessment of infant cognitive, language, and motor development on the Bayley Scales of Infant and Toddler Development (3rd edition) at 24 months of age with supplementary parent reporting on the Vinelands Adaptive Behavior Scales (2nd edition). Results: There were 394 live births, with 277 children (70%) completing the Bayley assessment at 24 months. There was no evidence of an association of prenatal exposure to monotherapy lamotrigine (−.74, SE = 2.9, 95% confidence interval [CI] = −6.5 to 5.0, p =.80) or levetiracetam (−1.57, SE = 3.1, 95% CI = −4.6 to 7.7, p =.62) with poorer infant cognition, following adjustment for other maternal and child factors in comparison to nonexposed children. Similar results were observed for language and motor scores. There was no evidence of an association between increasing doses of either lamotrigine or levetiracetam. Nor was there evidence that higher dose folic acid supplementation (≥5 mg/day) or convulsive seizure exposure was associated with child development scores. Continued infant exposure to antiseizure medications through breast milk was not associated with poorer outcomes, but the number of women breastfeeding beyond 3 months was low. Significance: These data are reassuring for infant development following in utero exposure to monotherapy lamotrigine or levetiracetam, but child development is dynamic, and future follow-up is required to rule out later emerging effects

Women with epilepsy preparing for pregnancy : a qualitative analysis

Women with epilepsy (WWE) are frequently presented with information when preparing for pregnancy, much of this includes statements of risk either concerning the health of the woman or her future child. Little is known about how women consider, use, are influenced by, trust and either act on or disregard information provided prior to conception, how they make decisions about conception, and what might influence their pregnancy planning. Studies have told us the numbers of women not receiving advice prior to getting pregnant, but these studies do not help us understand why this occurs and little is known of the potential to influence the involvement of women in preconception counselling. The rationale for this project was to develop understanding of the views of WWE, their beliefs, attitudes and perceptions of future pregnancy. Qualitative methods were applied to investigate the processes of WWE preparing for pregnancy. Purposive recruitment was undertaken for women aged 16 years to 45 years with a confirmed diagnosis of epilepsy of at least three months who have experience of being prescribed antiepileptic drugs for management of epilepsy. Women were recruited from regional epilepsy clinics across the NW of England, and invited to take part in either a focus group or clinic observation and follow-up interview. All interviews and focus groups were recorded and transcribed verbatim. All transcript data was managed using NVrVO 7 computer-assisted qualitative analysis software and analysis was informed by interpretative phenomenological analysis. A total of 85 women participated within this study, and 12 clinicians provided consent for clinic observation. The results highlight the value of examining the subjective experiences of reproductive aged WWE, and contribute important insights into the part played by women within the decision-making process, and in the broader context of their personal experience, relationships, family and social life. The most significant finding from analysis was the inconsistent use of the term 'planning' both by women and their clinicians. Women frequently defined planning as the intention to conceive, implying activities to improve epilepsy management occurred before the planning stage. For those women who defined planning as involving more complex activities and commitment to improve preconception health, many also longed for a more natural approach to pregnancy of simply trying to conceive. Barriers to planning included misunderstandings about what interventions were required and the timing of implementation, in addition to the influence of significant others and past pregnancy experience including experience of miscarriage, pregnancy termination or abortion, and the likelihood of engaging in preconception interventions. The presentation of risk information to women during their childbearing years presents a challenge requiring a careful balance between delivery of risk information and promotion of self-efficacy to successfully achieve planned pregnancy. It is contended that current practice fails to acknowledge women's active role in preconception decision-making. Risk information emphasises risks of harm to the unborn child heightening fear and worry and for some women perceptions of blame and selfishness when considering their needs above a future child. Future research is required to acknowledge the interconnectedness of factors likely to contribute or inhibit pregnancy planning, and the perceptions of risk, all of which were likely to act both independently and interdependently within the social context of the lives of WWE during their childbearing years.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The use of parent-completed questionnaires to investigate developmental outcomes in large populations of children exposed to antiseizure medications in pregnancy.

ObjectiveThis study was undertaken to assess the utility of the Ages and Stages Questionnaire-3rd Edition (ASQ-3) and the Vineland Adaptive Behavior Scales-2nd Edition (VABS-II) as neurodevelopmental screening tools for infants exposed to antiseizure medications in utero, and to examine their suitability for use in large-population signal generation initiatives.MethodsParticipants were women with epilepsy who were recruited from 21 hospitals in England and Northern Ireland during pregnancy between 2014 and 2016. Offspring were assessed at 24 months old using the Bayley Scales of Infant Development-3rd Edition (BSID-III), the VABS-II, and the ASQ-3 (n = 223). The sensitivity and specificity of the ASQ-3 and VABS-II to identify developmental delay at 24 months were examined, using the BSID-III to define cases.ResultsThe ASQ-3 identified 65 children (29.1%) as at risk of developmental delay at 24 months using standard referral criteria. Using a categorical approach and standard referral criteria to identify delay in the ASQ-3 and BSID-III at 24 months, the ASQ-3 showed excellent sensitivity (90.9%) and moderate specificity (74.1%). Utilizing different cut-points resulted in improved properties and may be preferred in certain contexts. The VABS-II exhibited the strongest psychometric properties when borderline impairment (>1 SD below the mean) was compared to BSID-III referral data (sensitivity = 100.0%, specificity = 96.6%).SignificanceBoth the ASQ-3 and VABS-II have good psychometric properties in a sample of children exposed to antiseizure medications when the purpose is the identification of at-risk groups. These findings identify the ASQ-3 as a measure that could be used effectively as part of a tiered surveillance system for teratogenic exposure by identifying a subset of individuals for more detailed investigations. Although the VABS-II has excellent psychometric properties, it is more labor-intensive for both the research team and participants and is available in fewer languages than the ASQ-3