Psychomotor development in Argentinean children aged 0-5 years

Paediatric motor difficulties and internalising problems: an integrative review on the environmental stress hypothesis

The current study aims to provide an in-depth analysis and extension of the Environmental Stress Hypothesis (ESH) framework, focusing on the complex interplay between poor motor skills and internalising problems like anxiety and depression. Using an integrative research review methodology, this study synthesises findings from 38 articles, both empirical and theoretical, building upon previous foundational works. The hypothesis posits that poor motor skills serve as a primary stressor, leading to internalising problems through various secondary stressors. A rigorous comparison of data was conducted, considering study design, findings, and methodologies-while exploring variables such as age, sex, and comorbidities. The study also enhances the ESH framework by including intrapersonal stressors and introducing resource buffers, including optimism and familial support as additional influencing factors. This multi-level approach yields a more nuanced and comprehensive ESH framework, highlighting the need for future studies to consider variables that intersect across multiple domains and how the relationship between poor motor skills and internalising problems may vary across different life stages.

Early object skill supports growth in role-differentiated bimanual manipulation in infants

The ability to coordinate the hands together to act on objects where each hand does something different is known as role-differentiated bimanual manipulation (RDBM). This study investigated two motor skills that may support the development of RDBM: infants' early object skill and their early sitting skill. To evaluate these potential predictors of RDBM growth, 90 infants were examined in a lab-based longitudinal design over a 9-month period. Latent growth modeling was used to estimate RDBM growth trajectories over 9 to 14 months from infants' object and sitting skills at 6 months, controlling for infant's sex, mother's education, and family income. Higher object skill, controlling for sitting skill, was related to a higher increase in RDBM over time. Sitting did not predict infants' change in RDBM over time, controlling for object skill. The ability to manage multiple objects may support collaborative hand use by providing infants with opportunities to practice actions that will be needed later for RDBM. By comparison, sitting may free the hands in an unspecified manner for manipulation.

Associations between parental and postnatal metal mixture exposure and developmental delays in a Taiwanese longitudinal birth cohort of preschool children

Studies have evaluated the impact of environmental exposure to neurotoxic metals on developmental delays (DDs). However, comprehensive understanding regarding the associations between parental and postnatal exposure to metal mixtures and the occurrence of DDs in offspring is limited. In this study, we assessed the relationships between parental and postnatal exposure to three metals (arsenic [As], cadmium [Cd], and lead [Pb], levels of which were measured in toenails) and suspected DDs (SDDs) in preschool children within a Taiwanese longitudinal birth cohort. In total between 2017 and 2021, 154 pairs of parents and their children under the age of 6 years were recruited, and 462 toenail samples and 154 completed questionnaires were collected. Metal concentrations in toenails were quantified using inductively coupled plasma-mass spectrometry after acid digestion of the toenails. We applied multivariable logistic regression and Bayesian kernel machine regression to evaluate the overall effect and to identify key components of the metal mixture that were associated with the SDD risk. Higher concentrations of As, Cd, and Pb were found in the toenails of the parents of children with SDDs compared with the toenails of the parents of children without SDDs. Our examination of the combined effects of exposure to the metal mixture revealed that As concentration in the father's toenail and Cd concentration in the mother's toenail were positively correlated with the risk of SDDs in their offspring. Notably, the effect of exposure to the metal mixture on the risk of SDDs was stronger in boys than in girls. Our findings suggest that parents taking measures to minimize their exposure to metals might enhance their children's developmental outcomes.

Evidence-Informed Milestones for Developmental Surveillance Tools

The Centers for Disease Control and Prevention's (CDC) Learn the Signs. Act Early. program, funded the American Academy of Pediatrics (AAP) to convene an expert working group to revise its developmental surveillance checklists. The goals of the group were to identify evidence-informed milestones to include in CDC checklists, clarify when most children can be expected to reach a milestone (to discourage a wait-and-see approach), and support clinical judgment regarding screening between recommended ages. Subject matter experts identified by the AAP established 11 criteria for CDC milestone checklists, including using milestones most children (≥75%) would be expected to achieve by specific health supervision visit ages and those that are easily observed in natural settings. A database of normative data for individual milestones, common screening and evaluation tools, and published clinical opinion was created to inform revisions. Application of the criteria established by the AAP working group and adding milestones for the 15- and 30-month health supervision visits resulted in a 26.4% reduction and 40.9% replacement of previous CDC milestones. One third of the retained milestones were transferred to different ages; 67.7% of those transferred were moved to older ages. Approximately 80% of the final milestones had normative data from ≥1 sources. Social-emotional and cognitive milestones had the least normative data. These criteria and revised checklists can be used to support developmental surveillance, clinical judgment regarding additional developmental screening, and research in developmental surveillance processes. Gaps in developmental data were identified particularly for social-emotional and cognitive milestones.

Teacher-Rated Executive Functions, Gender and Relative Age: Independent and Interactive Effects on Observed Fundamental Motor Skills in Kindergarteners

Fundamental motor skills (FMS) of children can be affected by different variables, such as executive functions (EF), gender and relative age. However, the effects of these variables on FMS have been scarce studied, especially in early childhood, and show inconsistent results. To clarify these relationships, this study was carried out. Its aim was to analyze whether EF, gender and relative age influenced FMS in 43 Spanish kindergarteners. A multimethod and mixed methods approach was used. Kindergarteners' teachers completed the Childhood Executive Functioning Inventory to know the children level of EF (working memory and inhibition control). Kindergarteners' parents complimented ad hoc questionnaire reporting the children gender and birth data (to know their relative age). A Nomothetic/Punctual/Multidimensional observational design was used to observe children FMS in their habitual motor sessions at school. Two-way ANOVAs were performed to know the independent and interactive effects of working memory level (lower/higher), inhibition control level (lower/higher), gender (boys/girls) and relative age (according to the birth semester in the year) on FMS. Results showed these variables have independent and interactive effects on some FMS, but not on others. FMS influenced by these variables vary depending what independent variable(s) is/are considered. Therefore, it can be concluded that the influences of teacher-rated EF, gender and relative age on observed FMS in kindergarteners are complex and specific. Results obtained must be taken into to design and implement instructional and intervention strategies, as well as educational and sport policy changes, especially in early childhood, when FMS are more malleable.

The Relationships between Sibling Characteristics and Motor Performance in 3- to 5-Year-Old Typically Developing Children

Siblings have been hypothesized to positively impact the motor performance of children by acting as examples and by providing a safe environment, but they may also negatively impact motor performance because they could compete for the parent’s time and care. Therefore, this study investigates the relationship between several sibling characteristics and motor performance in 3- to 5-year-old children. The sample consisted of 205 3- to 5-year-old children (mean age 50.9 ± 10.0 months, 52.2% boys). The Movement Assessment Battery for Children-2 was used to measure motor performance. The sibling variable was operationalized as the number of siblings present, the age difference between a child and its siblings, and the birth order position of a child. The confounding variables that were taken into account were the age, sex, and behavioral problems of the child and maternal education level. None of the investigated sibling variables were related to the total motor performance of a child after controlling for possible confounding variables. The absence of any associations between the sibling variables and motor performance might be explained by the characteristics of the study sample, the possibility that there is no linear relationship, or the presence of still unknown moderating or mediating factors.

Influence of the Psychomotor Profile in the Improvement of Learning in Early Childhood Education

The development of psychomotor skills in childhood enables children to organise the outside world through their bodies, contributing to their intellectual, affective, and social development. The present study aimed to longitudinally evaluate the psychomotor profile, throughout three academic years, of 3, 4 and 5-year-olds belonging to the second cycle of infant school, relating it descriptively to academic performance. The sample consisted of 82 subjects aged between 3 and 6 years throughout the study. The distribution of the sample was homogeneous, with 47.6% boys (n = 39) and 52.4% girls (n = 43). The results not only highlight the importance of the development and stimulation of motor skills from an early age for the overall development of the child, but also, when related to previous studies, show how they influence the development of human beings in adulthood.

The Relationship between Social Environmental Factors and Motor Performance in 3- to 12-Year-Old Typically Developing Children: A Systematic Review

Motor performance during childhood is important for prosperity in life, and the social environment may contain potentially important and modifiable factors associated with motor performance. Therefore, the aim of this systematic review was to identify social environmental factors associated with motor performance in 3- to 12-year-old typically developing children. Four electronic databases were searched, which resulted in 31 included studies. The methodological quality was determined using the Quality of Prognosis Studies in Systematic Reviews tool. Most studies were conducted in 3-6-year-old children. In the home environment, parental beliefs in the importance of physical activity and parental behaviors matching these beliefs were related to better motor performance of children, although these relationships were often sex-dependent. The school and sports environments were investigated much less, but some preliminary evidence was found that being better liked by peers, attending a classroom with a smaller age range, having more interaction with the teacher and classmates, and having a higher educated teacher was related to better motor performance. Further research is required to further unravel the relationship between the social environment and motor skills, with a specific focus on 6-12-year-old children and environments outside of the home environment.

The effects of touch-screen technology usage on hand skills among preschool children: a case-control study

Background: Little is known on how time spent on touch-screen technology affects the hand skills development of preschool children. This study aimed to investigate the effects of touch-screen technology usage on hand skills among preschool children.

Methods: Case-control design was employed to compare the hand skills of children who were engaged in touch-screen technology. A total of 128 participants aged between five and six years old who attended preschool were recruited and divided into two groups: high usage touch-screen technology (HUTSTG) and, low usage touch-screen technology (LUTSTG). Children's Hand Skills ability Questionnaire (CHSQ) and Assessment of Children's Hand Skills (ACHS) were used to evaluate the children's hand skills.

Results: There were significant differences in the hand skills of preschool children between HUTSTG and LUTSTG. Results showed that preschool children in LUTSTG had better hand skills in all domains of CHSQ (p≤0.001) and ACHS (p<0.001) as compared to HUTSTG.

Conclusion: Frequent use of touch-screen technology might cause disadvantages to the development of hand skills among preschool children.

Urban natural environments and motor development in early life

An emerging body of evidence has associated natural environments with improved brain development in children; however, these studies have mainly focused on cognition and available evidence for motor development is still scarce. This study aimed to evaluate the protective association of neighbourhood greenspace with motor development deficits in children. We obtained data on motor development deficits (separately for fine and gross motor developments) at sub-district level from routine medical check-up of children prior to enrolment into primary schools in the city of Berlin (2015-2016). Neighbourhood natural environments across the sub-districts were measured with three different metrics: the average of satellite-based normalized difference vegetation index (NDVI), the share of public green spaces, and the share of both public blue and green spaces (composite nature) across the sub-district. We applied negative binominal models to estimate the association between neighbourhood natural environments and fine and gross motor development deficits (one at a time), controlled for relevant sociodemographic indicators. Higher neighbourhood public green space and composite nature were significantly associated with lower risk of motor development deficits; however, the association were not statistically significant when using NDVI. Our findings, if confirmed by future studies, could provide evidence for implementing targeted interventions to enhance motor development in urban children.

Establishing New Norms for Developmental Milestones

BACKGROUND AND OBJECTIVES

Pediatric surveillance of young children depends on providers' assessment of developmental milestones, yet normative data are sparse. Our objectives were to develop new norms for common milestones to aid in clinical interpretation of milestone attainment.

METHODS

We analyzed responses to the developmental screening form of the Survey of Well-being of Young Children from 41 465 screens across 3 states. Associations between developmental status and a range of child characteristics were analyzed, and norms for individual questions were compared to guidelines regarding attainment of critical milestones from the Centers for Disease Control and Prevention (CDC).

RESULTS

A contemporary resource of normative data for developmental milestone attainment was established. Lower developmental status was associated with child age in the presence of positive behavioral screening scores (P < .01), social determinants of health (P < .01), Medicaid (P < .01), male sex (P < .01), and child race (P < .01). Comparisons between Survey of Well-being of Young Children developmental questions and CDC guidelines reveal that a high percentage of children are reported to pass milestones by the age at which the CDC states that "most children pass" and that an even higher percentage of children are reported to pass milestones by the age at which the CDC states that parents should "act early." An interactive data visualization tool that can assist clinicians in real-time developmental screening and surveillance interpretation is also provided.

CONCLUSIONS

Detailed normative data on individual developmental milestones can help clinicians guide caregivers' expectations for milestone attainment, thereby offering greater specificity to CDC guidelines.

Factors influencing developmental delay among young children in poor rural China: a latent variable approach

OBJECTIVES

The aims of the study were to determine the prevalence of suspected developmental delay in children living in poor areas of rural China and to investigate factors influencing child developmental delay.

DESIGN

A community-based, cross-sectional survey was conducted.Eighty-three villages in Shanxi and Guizhou Provinces, China.

PARTICIPANTS

A total of 2514 children aged 6-35 months and their primary caregivers.

OUTCOME MEASURES

Suspected child developmental delay was evaluated using the Ages & Stages Questionnaires-Chinese version. Caregivers' education and age, wealth index, child feeding index, parent-child interaction, number of books and Zung Self-Rating Depression Scale were reported by the primary caregivers. Haemoglobin levels were measured using a calibrated, automated analyser. Birth weight was obtained from medical records.

RESULTS

Overall, 35.7% of the surveyed children aged 6-35 months demonstrated suspected developmental delay. The prevalence of suspected developmental delay was inversely associated with age, with the prevalence among young children aged 6-11 months being almost double that of children aged 30-35 months (48.0% and 22.8%, respectively). Using a structural equation model, it was demonstrated that caregiver's care and stimulus factors and child's haemoglobin level were directly correlated, while caregiver's sociodemographic factors were indirectly associated with suspected developmental delay.

CONCLUSIONS

The prevalence of suspected developmental delay is high in poor rural areas of China, and appropriate interventions to improve child development are needed.

Similarities and differences in child development from birth to age 3 years by sex and across four countries: a cross-sectional, observational study

BACKGROUND

Knowledge about typical development is of fundamental importance for understanding and promoting child health and development. We aimed to ascertain when healthy children in four culturally and linguistically different countries attain developmental milestones and to identify similarities and differences across sexes and countries.

METHODS

In this cross-sectional, observational study, we recruited children aged 0-42 months and their caregivers between March 3, 2011, and May 18, 2015, at 22 health clinics in Argentina, India, South Africa, and Turkey. We obtained a healthy subsample, which excluded children with a low birthweight, perinatal complications, chronic illness, undernutrition, or anaemia, and children with missing health data. Using the Guide for Monitoring Child Development, caregivers described their child's development in seven domains: expressive and receptive language, gross and fine motor, play, relating, and self-help. Clinicians examining the children also completed a checklist about the child's health status. We used logit and probit regression models based on the lowest deviance information criterion to generate Bayesian point estimates and 95% credible intervals for the 50th percentile ages of attainment of 106 milestones. We assessed the significance of differences between sexes and countries using predefined criteria and regions of practical equivalence.

FINDINGS

Of 10 246 children recruited, 4949 children (48·3%) were included in the healthy subsample. For the 106 milestones assessed, the median age of attainment was equivalent for 102 (96%) milestones across sexes and 81 (76%) milestones across the four countries. Across countries, median ages of attainment were equivalent for all play milestones, 20 (77%) of 26 expressive language milestones, ten (67%) of 15 receptive language milestones, nine (82%) of 11 fine motor milestones, 14 (88%) of 16 gross motor milestones, and eight (73%) of 11 relating milestones. However, across the four countries the median age of attainment was equivalent for only two (22%) of nine milestones in the self-help domain.

INTERPRETATION

The ages of attainment of developmental milestones in healthy children, and the similarities and differences across sexes and country samples might aid the development of international tools to guide policy, service delivery, and intervention research, particularly in low-income and middle-income countries.

FUNDING

Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Mother's Perception of Children's Motor Development in Southern Brazil

Parents' perceptions of children's motor competence are important because they influence the way parents interact with their children to promote motor skills development. Thirty-six mothers of 16- to 66-month old children (61%, 22 boys and 39%, 14 girls, n = 36) estimated their child's performance while the child was being evaluated, by another trained researcher, with the same scale (Peabody Developmental Motor Scale 2nd Ed.) in a different room. Underestimations, accurate estimations, overestimations, and parental accuracy were investigated. Mothers overestimated significantly their child's stationary and locomotion skills and their GMQ and Total Motor Quotients (TMQ). Identical levels of motor performance were found in girls and boys, and estimation accuracy was similar for both genders. We discuss our results in the context of the parents' routines (little time interacting with children actively) and the relevance of their perceptions of the children's abilities as a further influence on the children's development and engagement in physical activities.

Screening preschool children for fine motor skills: environmental influence

[Purpose] The aim of this study was to investigate the influence of gender and family factors on performance in the fine motor domain of the Denver II developmental screening test. [Subjects and Methods] Data were obtained from 2038 healthy children, 999 boys (49%) and 1039 girls (51%) in four age groups: 0-24 months (57%), 25-40 months (21.1%), 41-56 months (10.4%), and 57-82 months (11.5%). [Results] Female gender, higher maternal age, especially in children older than 24 months, and higher maternal education were associated with earlier accomplishment of fine motor items. Higher socioeconomic status was correlated with fine motor skills more noticeably at young ages. [Conclusion] The results of this study support the role of environmental factors in the interpretation of fine motor test results and point to target groups for intervention, such as infants in the low socioeconomic group and preschool children of less educated mothers. Studies in different populations may reveal particular patterns that affect child development.

Motor profile of Portuguese preschool children on the Peabody Developmental Motor Scales-2: a cross-cultural study

This study was designed to examine the cultural sensitivity of the PDMS-2 for Portuguese preschool children aged 36-71 months. A total of 540 children (255 males and 285 females) from 15 public preschools of Viana do Castelo, Portugal, were assessed. Age and gender effects in motor performance were examined. Results indicated that PDMS-2 is valid instrument to differentiate Portuguese age groups. Girls presented higher scores than boys in the Grasping and Visuo-motor integration subtests and lower scores in the Object Manipulation subtest. Portuguese preschoolers performed above US norms on Grasping, Visual-motor integration, and Stationary subtests, and bellow on Locomotion and Object Manipulation subtests. Overall, Portuguese children showed better results on the Fine Motor Quotient comparing to the Gross Motor Quotient. These results underline different motor development profiles between Portuguese and American children.

Gross motor ability of native Greek, Roma, and Roma immigrant school-age children in Greece

The purpose of this study was to estimate and compare gross motor ability of children aged 7 to 10 years, all from Roma minority families (Romas, Roma immigrants) and families of indigenous Greeks. The sample consisted of 180 hildren (60 natives, 60 Romas, 60 Roma immigrants) studying in Greek public primary schools. The Test of Gross Motor Development scores showed that the group of indigenous Greek children had significantly higher performance in terms of locomotion skills, handling skills, and general motor ability compared to the groups of Roma and Roma immigrant children. No statistically significant differences were observed between the two other groups. These findings might be attributed to less participation of minority children in organized physical activities in and outside school, as well as to the reduced parental encouragement for attending related activities.

A guide for monitoring child development in low- and middle-income countries

OBJECTIVE

In low- and middle-income countries, methods for clinicians to address difficulties in language, social-emotional, cognitive, behavioral, or neuromotor development during early childhood are lacking. To fill this gap, we designed, in Turkey, the Guide for Monitoring Child Development, which aims to aid clinicians in monitoring and supporting child development and the early detection and management of developmental difficulties. The Guide for Monitoring Child Development monitoring component is a practical, open-ended interview that catalyzes communication between clinicians and caregivers and obtains a portrayal of the child's development. We report on the development and psychometric properties of the Guide for Monitoring Child Development monitoring component for children aged 0 to 24 months.

METHODS

We examined the ages of attainment of Guide for Monitoring Child Development milestones and internal consistency in a cross-sectional study of healthy children receiving well-child care (study 1). In 2 clinical samples, we studied the interrater reliability between medical students and a child development specialist administering the guide (study 2), as well as the concurrent validity of the guide administered during a health visit and a comprehensive developmental assessment (study 3).

RESULTS

In study 1 (N = 510), item-total scale correlations ranged from 0.28 to 0.91. An age-dependent attainment pattern was seen in all of the milestones. In study 2 (N = 92), interrater reliability between medical-student pairs and between the child development specialist and students was high (kappa scores were 0.83-0.88). In study 3 (N = 79), the sensitivity, specificity, and positive and negative predictive values were 0.88, 0.93, 0.84, and 0.94, respectively.

CONCLUSIONS

The Guide for Monitoring Child Development is an innovative method for monitoring child development that is designed specifically for use by health care providers in low- and middle-income countries. Studies in Turkey provide preliminary evidence for its reliability and validity.

Screening for developmental problems at primary care level: a field programme in San Isidro, Argentina

Information on prevalence and type of problems of psychomotor development (PPD) is necessary for implementation of specific care programmes at field level. With the purpose of obtaining this information, a screening test, the Prueba Nacional de Pesquisa (PRUNAPE) for PPD was implemented in three health centres in San Isidro, a city near Buenos Aires, attended by different socio-economic groups: centres A and B were located in the inner city, and C in a middle-class area. The test was administered by three previously trained paediatricians to 839 apparently healthy children aged 0-5 years. The failure rates were 24%, 19% and 16% in centres A, B and C respectively (20% in total). Out of the 170 children failing the test and referred to hospital for diagnosis and treatment, only 96 complied and went through a series of studies carried out by a previously prepared multidisciplinary team. With the exception of children who failed the Battelle test [classified as Global Developmental Delay (GDD)], final diagnoses were classified according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition: GDD (60 children), pervasive developmental disorders (11), communication disorders (10), motor disorders (6, of whom 2 were with cerebral palsy), attention deficit disorders (5), attachment disorders (2), normal children (3). Co-morbidity was present in 22 affected children. Forty-three per cent of children failing the test did not attend hospital or did not complete studies because of major social and family problems, the family not living in the area, or the parents preferring to consult their own paediatrician. Health centres and children not selected in a randomised way, and a significant proportion of them not complying with the indication of hospital referral were major sources of bias, so that PPD prevalences, positive and negative predictive values should be interpreted with great caution. Further studies accounting for these sources of bias are needed to confirm the observed prevalence of PPD. Training of health personnel, at hospital and health centre level, priority settings, and operational research to evaluate effectiveness of treatments and care delivery systems at field level are necessary in Argentina for optimal use of limited healthcare resources.

The movement assessment battery for children: similarities and differences between 4- and 5-year-old children from Flanders and the United States

PURPOSE

To explore the possibility that 4- and 5-year-old Flemish children would perform differently from children of the same age in the US standardization sample of the Movement Assessment Battery for Children (M-ABC).

PARTICIPANTS

Two hundred sixty-seven 4-year-old and 239 5-year-old Flemish children without known impairments, from regular schools, took part in the study (260 boys, 246 girls).

METHODS

All children were individually assessed using the M-ABC.

RESULTS

: The total M-ABC score of the 4-year-old children was similar to that of their peers in the United States. The 5-year-old Flemish children performed significantly better, although the effect size of the difference was very small. Of the 5-year-old children, one scored at the 5th percentile (0.4%) and 5.0% of the children scored below the 15th percentile.

CONCLUSIONS

United States norms are appropriate for 4-year-old Flemish children but require adjustment if they are to identify 5-year-old Flemish children with mild motor impairment.

Developmental milestones and self-feeding behaviors in infants and toddlers

OBJECTIVES

To identify ages at which gross motor developmental milestones and fine motor skills required for self-feeding were reported by primary caregivers and to relate these self-feeding skills to energy and nutrient intakes.

DESIGN

Cross-sectional survey of households with infants/toddlers, ages 4 to 24 months.

SUBJECTS/SETTING

Telephone survey using a national random sample of infants and toddlers (n=3,022).

METHODS

Primary caregivers reported their children's food intake (one 24-hour recall), the ages when caregivers reported self-feeding skills were shown, and the number of teeth.

STATISTICAL ANALYSES PERFORMED

Children's reported ages for gross motor developmental milestones, self-feeding skills, and the number of erupted teeth were summarized. Using t tests, differences in energy and nutrient intake were determined by age groupings and by the absence or presence of each self-feeding skill.

RESULTS

Self-feeding skills achieved in the first 2 years and details about age ranges at which developmental readiness to self-feed were evidenced are described. The ages at which children were reported to show gross motor developmental milestones and eruption of teeth occurred within expected age ranges. A majority of the children who were reported to show developmental readiness to self-feed at an earlier age (7 to 14 months) had higher intakes of energy and most nutrients than those who did not. By 15 to 18 months, most of the children were reported to show comparable self-feeding skills regardless of whether they self-fed earlier or later.

APPLICATIONS/CONCLUSIONS

Assuming a variety of nutritious foods are offered to infants and toddlers, caregivers may encourage self-feeding without concern for jeopardizing energy and nutrient adequacy. In the first year, the addition of foods that require chewing should reflect the number of erupted teeth.

Epilepsy and pregnancy: Report of an Epilepsy Research Foundation Workshop

Pregnancy in women with epilepsy (WWE) is known to be associated with a higher risk of congenital malformations than is associated with pregnancy in non-epileptic women. Several factors have been identified to account for the increased risk, including the direct teratogenic effects of antiepileptic drug (AED) therapy, indirect effects of these drugs by interfering with folate metabolism, genetic abnormalities in drug or folate metabolism, and possibly an arrhythmogenic effect of maternal drug therapy on the embryonic heart, leading to ischaemia in developing tissues. A harmful effect of maternal seizures on the developing embryo has not been proven, although seizures and status epilepticus account for most of the excess maternal mortality in women with epilepsy. Abrupt withdrawal of drug therapy by the mother may be an important contributory factor. Less is known about the psychomotor development of children born to mothers with epilepsy because few studies have been designed to follow their progress throughout childhood. Retrospective studies suggest that impaired cognitive development may be associated with maternal drug therapy, particularly valproate. There is an urgent need to evaluate these risks and, with this in mind, several prospective registers have been set up to collect data from pregnancies in women with epilepsy.