Mothers-to-be who rely on medications to manage seizures and psychiatric conditions during pregnancy face a difficult dilemma: The drugs that help manage their health may also pose risks to their unborn child.

Data published in Nature Communications from researchers at the Dana and David Dornsife School of Public Health indicate that exposure to valproate, topiramate and carbamazepine leads to some additional risk of autism or intellectual disability — though the absolute risk is low.

“Our findings suggest that while certain medications may pose some risk, lamotrigine may be a less risky option,” says co-senior author Brian K. Lee, a professor in the Dornsife School of Public Health. “Active monitoring of any antiseizure medication is critical to ensure safety and effectiveness, particularly during pregnancy.”

The study analyzed data from over three million children in the United Kingdom and Sweden — including 17,495 who were exposed to antiseizure medications before birth. Children exposed to topiramate in the womb were 2.5 times more likely to be diagnosed with intellectual disability by age 12, raising their risk to 2.1% compared to unexposed children.

Nonetheless, the researchers do not suggest avoiding these medications entirely. Instead, they encourage patients to discuss their options with their doctor to find the safest and most effective treatment.

Previous findings have also linked valproate, topiramate and carbamazepine with neurodevelopmental diagnoses in offspring, such as autism, intellectual disability and ADHD.

Despite the study’s large sample size, the authors emphasize the need for further research across multiple countries to assess the safety of these drugs, especially as new treatments emerge.