(SLC-032) Prenatal Exposure to Antiseizure Medications and Risk of ADHD in Children

Tuesday, August 26, 2025

12:15 PM - 1:15 PM ET

Co-Author(s)

Payam Peymani

College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Manitoba, Canada
AB

Anick Berard

Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada, Canada
Alekhya Lavu, PharmD, PhD

Pharmacoepidemiologist
Certara, Canada
CL

Christine Leong

College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Manitoba, Canada
JF

Jamie Falk

College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Manitoba, Canada
JD

Joseph A. C. Delaney

University of Washington, Washington, United States
KK

Kaarina Kowalec

College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Manitoba, Canada
MN

Marcus Ng

Section of Neurology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada, Manitoba, Canada
CR

Chelsea Ruth

Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Canada
LA

Laila Aboulatta

College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Manitoba, Canada
SA

Silvia Alessi-Severini

College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Manitoba, Canada
RD

Roxana Dragan

Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada, Manitoba, Canada

Presenting Author(s)

SE

Sherif Eltonsy

College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Manitoba, Canada

Background: Antiseizure medications (ASMs) are frequently prescribed during pregnancy, but their potential effects on neurodevelopmental outcomes in children, such as attention-deficit/hyperactivity disorder (ADHD), remain uncertain.

Objectives: To assess the association between prenatal ASM exposure during the second and/or third trimester and the risk of ADHD in offspring.

Methods: A population-based cohort study was conducted using data from the Manitoba Research Data Repository (1998-2019). Pregnancies were classified by epilepsy diagnosis and ASM exposure. High-Dimensional Propensity Score (HDPS) analysis accounted for maternal factors, including age, asthma, chronic pain, psychiatric disorders, area of residence, socioeconomic status, multiple births, diabetes, hypertension, and the 300 most frequent covariates. While HDPS adjustment accounted for diagnostic codes, severity assessment remains limited in administrative data. Inverse Probability of Treatment Weighting (IPTW) with Cox proportional hazards regression was applied to assess ADHD risk. Children were followed from birth until ADHD diagnosis, age 18, death, or study end.

Results: The study included 251,109 pregnancies, of which 3,271 involved ASM exposure during pregnancy. ADHD incidence was 15.1% among children exposed to ASMs with maternal epilepsy, 18.6% in those exposed without maternal epilepsy, and 11.2% in the unexposed group without epilepsy. HDPS IPTW-adjusted models showed an increased risk of ADHD across the overall exposed cohort (HR = 1.99, 95% CI: 1.96-2.02), particularly among pregnancies without epilepsy (HR = 2.38, 95% CI: 2.34-2.42). No significant association was observed in pregnancies with epilepsy (HR = 1.00, 95% CI: 0.96-1.05).

Conclusions: Prenatal exposure to ASMs was associated with a higher risk of ADHD in children, particularly in pregnancies without maternal epilepsy. These findings suggest a potential association and underscore the need for further research and careful consideration of ASM use during pregnancy, especially for non-epilepsy-related indications.