Psychomotor development was assessed in preschool children exposed to antiepileptic drugs (AED) in utero as part of a population-based longitudinal follow-up study of children born to women with meticulously treated epilepsy during pregnancy at the Karolinska Institute, Stockholm, Sweden. Exposed (n=67) and unexposed (n=66) children were tested with the Griffiths’ test at 4.5-5 yrs of age in 6 subsets: locomotor function, personal and social behavior, hearing and speech, eye and hand coordination, performance, and practical reasoning. The Griffiths’ test evaluates the child’s behavior and is widely used in Sweden as the standardized measure of psychomotor development in preschool children. Global scores showed no significant differences in the two groups, but exposed children obtained slightly lower scores in 4 of the 6 subtests. Children exposed to phenytoin in utero (n=16) showed a significant but subtle reduction in locomotor function. Carbamazepine in utero (n=35) had no measurable adverse effect. The majority (85%) received monotherapy in low doses. Exposed children had significantly fewer siblings (p < 0.01), and AED-treated mothers were more likely to have lower levels of education (p < 0.001) than the unexposed group. Socioeconomic status was otherwise similar in the two groups. The first evaluation of this cohort of children had shown a significant increase in minor anomalies in the exposed group, but psychomotor development at 9 mos of age had revealed no differences in the scores of the 2 groups. [1]

COMMENT. Psychomotor development, especially locomotor function, shows significant but subtle delays in preschool children exposed in utero to phenytoin but not carbamazepine. Previous reports, cited by the authors, have found evidence of developmental delay in children exposed to carbamazepine. The differences between AED-exposed and unexposed children are not observed when tested at 9 months of age, but could be more obvious at school age. Further follow-up of the cohort is planned.