The international registry of antiepileptic drugs and pregnancy. Carbamazepine, phenytoin, phenobarbital, lamotrigine, oxcarbazepine are some of the antiepileptics used even during pregnancy. Phenytoin, valproate, carbamezapine and lamotrigine are all pregnancy category d. To assess the safety of the newer antiepileptic drugs aeds during pregnancy. Chesham lane chalfont st peter buckinghamshire sl9 0rj map contact. Use of antiepileptic drugs during pregnancy and risk of.
It was not very many generations ago that women with epilepsy were routinely advised. Brain regions and neuronal pathways certain parts of the brain govern specific functions. Teratogenic effects of antiepileptic drugs the lancet. London office can mezzanine 4951 east road, london, n1 6ah. The diagnosis of epilepsy needs to be validated, the epilepsy syndrome elucidated, optimal antiepileptic drug treatment established and folate supplements given. Yet most of the antiepileptic drugs taken by pregnant women expose the unborn child to the risk. When the brain is working normally the nerve cells talk to each other using controlled electrical signals from one nerve cell to another.
The goal for all concerned is a healthy, seizurefree mother and an undamaged child. Data on aed use and maternal characteristics were collected through phone interviews at enrollment. Doctors are looking for the same kind of information when choosing the best medications to prescribe for young women. Antiepileptic drugs in women with epilepsy during pregnancy. Comparative safety of 11 antiepileptic drugs used during pregnancy. Point to sensory, motor, association and visual cortex to highlight specific functions. As the number of aed prescriptions has dramatically increased in reproductiveaged women with a variety of neuropsychiatric indications. Epilepsy is the most common neurologic disorder that requires continuous treatment during pregnancy, and antiepileptic drugs aeds constitute one of the most frequent chronic teratogen exposures fairgrieve et al. The international registry of antiepileptic drugs and pregnancy eurap reported in 2006 on 1882 women with epilepsy whose seizure control and treatment was prospectively recorded. Data was obtained from 1956 pregnancies in 1882 women with epilepsy.
Women with epilepsy were once counseled to avoid pregnancy, but epilepsy is no longer considered a contraindication to pregnancy. A recent study from the united states found that antiepileptic drug use during pregnancy is increasing, especially for the newer drugs. Anticonvulsant drugs knowledge for medical students and. It is important to monitor antiepileptic drug levels at regular intervals because dosage adjustment may be required as a result of the altered pharmacokinetics of pregnancy. The average major malformation rate among all aed exposures varies between 3. As more and more antiepileptics are brought to the market, we need to know which of these medications are suitable in pregnancy, said mark yerby, md, associate professor of neurology, public health, and obstetrics and gynecology at the oregon health sciences university in portland.
Pdf most infants born to women with epilepsy are healthy, but there are increased risks related to in utero antiepileptic drug aed exposure. Advise pregnant women with epilepsy who take antiepileptic medication to take 5 mg folic acid daily for their entire pregnancy in every pregnancies, between two and five infants are born to women with epilepsy. Update on monotherapy findings aed pregnancy registry. Patterns and predictors for prescription of psychotropics. Uncontrolled epilepsy in a pregnant woman is a serious and potentially lifethreatening condition for both mother and child. Some are the direct result of seizures, some result from the drug treatment, and some are secondary handicaps because of stigmatisation. Over 90 percent of women with epilepsy will have good outcomes. Management of epilepsy during preconception, pregnancy, and the. Your weight and blood pressure will be checked at every visit, and you might need frequent blood tests to monitor your medication level.
Before conception, a comprehensive management plan is desirable. The north american aed antiepileptic drug pregnancy registry announces updated. Data on aed use and maternal characteristics were collected through phone interviews at enrollment, at 7 months gestation, and postpartum. The reported major malformation rates in the general population vary between 1. While sharing a common property of suppressing seizures, antiseizure drugs have many different pharmacologic profiles that are relevant when selecting and prescribing these agents in patients with epilepsy and other conditions. Women with epilepsy in pregnancy should be seen by obstetricians and neurologists in a multidisciplinary team environment. Comparative safety of antiepileptic drugs during pregnancy s. Prevalence of epilepsy in pregnant women has been estimated at.
Possible teratogenic effects of antiepileptic drugs are therefore of wide concern and the risks imposed by the drugs must be. The infant, whose mother has taken an antiepileptic drug aed during pregnancy, should be monitored for excessive sleepiness, irritability, and weight loss. The effect of pregnancy on the natural history of epilepsy. It was found in the north american antiepileptic drug pregnancy. In the past decade, findings have highlighted that it is no longer sufficient to only consider the association between firsttrimester exposure and the risk for structural teratogenicity, because prenatal aed.
Women with epilepsy were once counseled to avoid pregnancy, but epilepsy is no. Treating for two works to understand trends in medicine among pregnant women and women of reproductive age, and provide women and healthcare providers with information about the safety or risk of using specific medicines during pregnancy. This tells the body to do everything it needs or wants to do. If youre taking antiseizure medications, your health care provider might recommend oral vitamin k supplements during the last month of pregnancy. National health and medical research council guidelines 2000 recommend that all. The use of antiepileptic drugs aed is common in women of childbearing age. There are several important issues to be addressed by the care team when a woman with seizures becomes pregnant. Anticonvulsant drugs are classified as either classic or newer anticonvulsants. Anticonvulsants antiepileptics or aeds helps to normalise the way nerve impulses travel along the nerve cells which helps prevent or treat seizures. In terms of incidence, 2 to 5% of the general population is believed to be likely to experience an epileptic. If any of these symptoms occur, contact your pediatrician or other healthcare provider about whether these symptoms could be related to the medication in the mothers milk. Your specialist will assess the risk and benefit of the medicines you are on to make the decision. There may be an increase in the clearance and resultant decrease in the blood concentration of lamotrigine, phenytoin, and to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy. Association of british neurologists, epilepsy action, royal college of general practitioners, royal college of midwives and the royal college of physicians.
Antiepileptic drugs in pregnancy and lactation uq espace. Early pregnancy can be an opportunity to screen for structural abnormalities. Antiepileptic drugs are also frequently used for other indications, such as migraine, pain syndromes, and psychiatric disorders, which are prevalent among women of childbearing age. Epilepsy in pregnancy this is the first edition of this guideline, produced by the royal college of obstetricians and gynaecologists rcog and endorsed by the following organisations. Most pregnant women with epilepsy will need to take at least one antiepileptic drug.
Antiepileptic medicines can cause birth defects in pregnancy. These results continue to indicate that the prenatal. Prescribing antiepileptic drugs aeds in pregnancy is a challenge to the clinician. The choice of drug is guided by the type of seizure. Such treatment, and the epilepsy itself, are associated with important adverse outcomes in the child. Most women with active epilepsy need treatment with antiepileptic drugs during pregnancy.
Seizure frequency remained unchanged throughout pregnancy in 63. The risks associated with epilepsy and the risks of antiepileptic drug aed. Comparative safety of antiepileptic drugs during pregnancy. Cdcs national center on birth defects and developmental disabilities ncbddd is working to improve the health of women and babies through its treating for two. When many drugs fell off the patent cliff in 2012 and 20, switching from a brand name drug to a generic was rampant. Although prenatal exposure to antiepileptic drugs aeds is known to impart relatively higher risks of major congenital malformations, prospective studies have provided refined data that allow us to differentiate the risks of different types and doses of aeds. If antiepileptics are continued in pregnancy, monotherapy with the lowest effective dose is preferred, with adjustment made to take account of changes in plasma levels associated with pregnancy. Management of epilepsy and pregnancy bioline international. One study 1 reported that prenatal aed exposure occurred in 2. Antiepileptic drug use during pregnancy seizure european. The safety of antiepileptic drug use in pregnancy involves.
A multitude of questions arise that must be addressed even prior to conception. In utero valproate exposure continues to show the highest risk of. Antenatal ultrasonography, antiepileptic drug, congenital malformation, epilepsy, gender issues, pregnancy. Rcog guidelines cover the subject of pregnancy in women. Around 36 in every 1,000 pregnant women have epilepsy, and many of them are taking antiepileptic therapy. There is an increased risk of birth defects with the use of anticonvulsants, particularly. The risk increases with the number of antiepileptic medicines taken. During pregnancy, youll see your health care provider often. April 28, 2009 seattle, washington new guidelines confirm that pregnancy is relatively safe for women with epilepsy, but panelists say the antiepileptic valproate should be avoided if possible. Comparat ive safet y of 11 antiepileptic drugs used during pregnancy t he north american aed antiepileptic drug pregnancy registry announces updated results based on a 2012 study on the comparative safety of aed monotherapy during pregnancy.
Seizure control during the second and third trimesters was compared to that in the first trimester. The clinical management of women with epilepsy on antiepileptic drugs. The study population was pregnant women who enrolled in the north american aed pregnancy registry between 1997 and 2011. Keeping current on evidencebased guidelines and practice parameters is critical for epilepsy professionals to provide quality care to patients and families. Use of antiepileptic medications during pregnancy cdc. These guidelines address both the effects of epilepsy in the gynecological, obstetric. Women who are pregnant or considering pregnancy are rightly concerned about whether the medicines they take might cause birth defects or other harm to their developing baby. Holmes, md for the north american aed pregnancy registry abstract objective. The management of pregnant women with epilepsy obstetrics and. Current state of knowledge on the risk of malformations and of neurodevelopmental disorders synthesis 5 i background n europe, an estimated 2. In women with proven epilepsy, it may be dangerous to stop or even change the aed regimen during pregnancy. New guidelines released on pregnancy with epilepsy medscape. Janz d, bossi l, dam m, helge h, richens a, schmidt d eds. In the united states, the food and drug administration fda is one source of guidance.
574 194 229 581 28 906 305 1285 96 1059 1343 235 804 495 1282 1002 1437 554 1392 160 317 990 980 578 1075 1191 1301 1298 1005 185 972 885 690