“Between Scylla and Charybdis”: the influence of pregravid preparation on mental development of children born to mothers with epilepsy
Authors: Krasko A. S. , Mikhailova N. F. , Larina I. V. , Mikhailov V. A. , Odintsova G. V. 
Published: January 2025

Background. The emergence of the latest pharmacotherapeutic methods opened up new opportunities for delivery of healthy children born to women with epilepsy, whereas comprehensive pregravid preparation became the “gold standard” of treatment, reducing the risks of teratogenesis and the appearance of mental development disorders and adaptation in offspring.

Objective: to study an effect of a comprehensive pregravid preparation for women with epilepsy on mental development and adaptation in paired children.

Material and methods. A multicenter, retrospective, uncontrolled, open, observational study assessing mental development level in children born to women with epilepsy was conducted. The study involved 176 subjects: 88 children (aged 3–9 years) and paired mothers with epilepsy. Several methods we used: a medical questionnaire (biographical data, clinical data on the form, course and treatment of maternal epilepsy, course of pregnancy and childbirth, as well as information on pediatric early development), Luria neuropsychological batteries adapted by J.M. Glozman (for preschool and primary school children), Wechsler Intelligence Scale for Children (WISC) (for children aged 5 years and older), Child Behavior Checklist (CBCL) forms for parents (by T. Achenbach), and attention deficit hyperactivity disorder and other behavioral dysfunctions questionnaire modified by N.N. Zavadenko (for children aged 5 years and older).

Results. In children born to mothers who did not undergo pregravid preparation, the overall indicator of developmental and adaptation disorders was higher: anxiety, attention problems, motor awkwardness, hyperactivity and internalization problems were more pronounced. They also had a higher overall index of neuropsychological disorders – gnosis, phonemic hearing, understanding of reversed speech and speech logic, and logical operations were specifically affected. A comparison of age groups showed that by the age of 7–9 years old, children born to mothers who underwent pregravid preparation were better compensated. Seizures during pregnancy is a predictor for developing large number of pediatric mental development disorders in the future (somatic problems, disorders of socialization and attention, motor awkwardness, externalization problems), whereas conducting pregravid preparation significantly lowers the predictive power of such effect, which allows to consider it as a moderator. Pregravid preparation is also a moderator that lowers a negative impact of toxicosis on probability for deliver a child with externalization (aggression) and delayed neurodynamic development.

Conclusion. A comprehensive pregravid preparation exhibits a moderating effect: it lowers a negative impact of epileptic seizures and pregnancy complications (toxicosis) on further mental development and adaptation of children, as well as increases their compensatory capabilities. The study results have both scientific and significance for neurologists, obstetricians as well as gynecologists and clinical psychologists.