Does in utero exposure to antiepileptic drugs affect the trajectory of cognitive development from 2 to 6 years of age? ; Vaikuttaako raskaudenaikainen altistuminen epilepsialääkkeille lapsen kognition kehityskaareen 2 vuoden iästä 6 vuoden ikään?

Antiepileptic drugs (AED) are vital for treating epilepsy, but their use in pregnancy carries significant risks. Prenatal exposure to some AEDs like valproic acid increases the risk of teratogenicity and deficits in cognitive development in children. The impact of AEDs at different ages has been studied but their effect on the trajectory of cognitive development remains unknown. This study assessed the cognitive performance of children with prenatal AED exposure and unexposed controls using Bayley scales of infant and toddler development III (BSID-III) at 2 years and Weschler intelligence scales for children (WISC-IV) at 6 years of age. The association between 2- and 6-year outcomes was analyzed with separate ANCOVA models for each WISC-IV subscale. BSID-III subscales were used as the covariates and the models were adjusted for confounding factors. BSID-III scores in cognitive (B=6.70, p=0.01) and language (B=6.92, p=0.008) subscales were significantly associated with the WISC-IV working memory scores in controls but not in the exposed group. The groups were also found to differ in their intercorrelations between BSID-III subscale scores. Scores at 2 years were not associated with later results in exposed children as they were in controls. This may suggest that the cognitive development trajectory of AED-exposed children differs from that of unexposed controls, possibly following an alternate projection. Developmental trajectories should be considered when investigating the cognitive effects of prenatal AED exposure. The finding of lacking correlations of BSID-III subscales also raises cause for future investigation of the structure of cognition in AED exposed children.