Children of mothers with epilepsy exposed to antiepileptic drugs during pregnancy Long-term neurocognitive and behavioral functioning from a family perspective

This dissertation shows that the use of antiepileptic drugs in women with epilepsy of childbearing age needs continuous attention, also in light of long-term development in children. Treatment continuation during pregnancy is a must for most women with active epilepsy, whereas prenatal exposure to antiepileptic drugs is associated with increased risks of congenital malformations, which indicates the associated challenges of antiepileptic drug use. In the past two decades, more attention has also been paid to possible long-term effects of prenatal exposure to antiepileptic drugs. However, in order to help women and their treating physicians to make a well-informed choice on medication use during pregnancy, still more information is needed, specifically on newer antiepileptic drugs, the potential spectrum of developmental side effects, and the role of factors modifying the teratogenic risks and eventual outcome. The aim of this thesis therefore was to obtain more knowledge about the long-term effects of prenatal exposure to four common antiepileptic drug monotherapies (valproate, carbamazepine, lamotrigine or levetiracetam) on the neurocognitive and behavioral development of school-aged children. The contribution of distinct family factors in maternal epilepsy, a chronic medical condition, has also been investigated, including a description of the wellbeing of mothers with epilepsy. With this thesis we hope to provide more information to future women with epilepsy who are or want to become pregnant and to provide starting points for treatment and support of children who have been exposed to AEDs during pregnancy and their families.