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Antiepileptic drug (AED) exposure during the first trimester leads to higher rates of congenital malformations, but cognitive and behavioral effects of in utero AED exposure are not well understood. In this ongoing prospective observational study, researchers enrolled pregnant women with epilepsy who used monotherapy with one of four AEDs (carbamazepine, lamotrigine, phenytoin, or valproate). The primary endpoint was IQ of offspring at 6 years of age; this report was a planned interim analysis at 4.5 years of age in 209 children.
Children exposed to valproate in utero had lower mean IQ (96) than did children exposed to other AEDs in utero (carbamazepine, 107; lamotrigine, 106; phenytoin, 106). After correction for maternal IQ, offspring expo…