The drugs that control epilepsy may pose a risk to a fetus if a woman takes them while pregnant. But it may not be good for the fetus if its mother is having seizures, either, which presents a dilemma for women and their doctors. In this study, researchers in the United Kingdom looked at the children of women with epilepsy.

What the researchers wanted to know: Do children whose mothers took antiepileptic drugs during pregnancy have more developmental problems than children whose mothers have epilepsy but didn't take drugs during pregnancy?

What they did: Over about 10 years, the researchers identified women with epilepsy and children ages 6 months to 16 years at three clinics in Manchester and Liverpool. They recorded deformities on all children and gave neuropsychological tests to children between 6 and 16. Two hundred nineteen women participated, with 375 of their children. In a little over a quarter of those pregnancies, the women weren't taking antiepileptic drugs.

What they found: Children exposed to antiepileptic drugs in utero had a lower verbal IQ than children who weren't exposed. Valproate seemed to be worse than carbamazepine, but children who were exposed to lower doses of valproate (less than 800 mg a day) seemed to do better. Deformities, although rare, were also more common in children exposed to valproate.

What the study means to you: Unfortunately, there's still no answer to the question: Which is worse, drugs or seizures? The researchers suggest offering women drugs other than valproate, or combining low-dose valproate with other drugs. More studies are needed, they say. It will be difficult for any study to tell the difference between the effects of seizures and drugs, because women who have worse seizures probably also take more drugs.

Caveats: Over half of the women whom the researchers approached didn't want to join the study; women whose children had problems were probably more likely to agree to take part.

Find out more: Guidelines for Scottish obstetricians on dealing with epilepsy during pregnancy: www.sign.ac.uk

Read the article: Adab, N., et al. "The Longer Term Outcome of Children Born to Mothers With Epilepsy." Journal of Neurology, Neurosurgery, and Psychiatry. November 2004, Vol. 75, pp. 1575-1583.

Abstract online: http://jnnp.bmjjournals.com