School Performance Amongst Children of Mothers with Epilepsy : A Nationwide Cohort Study

Objective: We examined whether exposure to antiepileptic drugs (AED) during pregnancy affects the grade point average (GPA) in the final report of comprehensive school in children born to women with epilepsy (WWE). Methods: Fertile-aged (15–49 years) women who received the first special reimbursement for AEDs during 1985–1994 were identified from the Social Insurance Institution (n = 6 535). A reference cohort (n = 14 704) was identified from the Population Register Centre (PRC)*. Children born after the reimbursement were identified from PRC and Medical Birth Register (n = 5 877 WWE; n = 15 344 reference cohort). From Statistics Finland information on GPA (theoretical and all subjects) was obtained for the first-born children during 1996-2012. Difference in the mean GPAs between the cohorts and AED exposure groups were estimated with linear regression and 95 % confidence intervals. Results: The mean GPAs of both subjects were lower in the epilepsy cohort (7.44 and 7.38) compared to the reference cohort (7.63 and 7.50). Adjustment for confounders reduced the differences in both subjects. GPA of theoretical subjects was lower for children exposed to valproate than other children born to WWE. Children exposed to oxcarbazepine or carbamazepine had a significantly lower mean GPA for both subjects compared to the reference group. The children born to WWE without AEDs during pregnancy also had lower GPAs than children in the reference group. Conclusion: Exposure to AEDs during pregnancy was associated with significantly lower GPAs of both categories, especially related to oxcarbazepine and valproate, probably reflecting an impact of maternal epilepsy or AED on cognitive development of the offspring. *From 1.1.2020 on, PRC is Digital and Population Data Services Agency