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Published on: May 16, 2019
Pregnancy and epilepsy.
1Comprehensive Epilepsy Center, Department of Neurology, Weill Cornell Medical College, New York, New York 10021, USA. clharden@med.cornell.edu
Seminars in Neurology
|October 18, 2007
Summary
Valproate use during pregnancy increases teratogenic risk and may lower offspring verbal IQ. Most women with epilepsy can maintain seizure freedom throughout pregnancy with proper management.
Area of Science:
- Obstetrics and Gynecology
- Neurology
- Pharmacology
Background:
- Managing epilepsy in pregnant women is complex, requiring careful consideration of antiepileptic drugs (AEDs).
- Advances in surveillance and understanding of teratogenesis have improved risk assessment for AEDs.
- Pregnancy registries provide crucial data on AED safety and efficacy.
Purpose of the Study:
- To review current knowledge on AED management in pregnant women with epilepsy.
- To highlight specific teratogenic risks associated with certain AEDs, particularly valproate.
- To discuss strategies for maintaining seizure control and optimizing AED therapy during pregnancy.
Main Methods:
- Analysis of data from worldwide AED pregnancy registries.
- Review of retrospective reports and clinical surveillance findings.
- Discussion of therapeutic monitoring and dosing considerations for specific AEDs.
Main Results:
- Valproate is associated with increased teratogenic risk compared to other AEDs.
- Valproate use and maternal convulsive seizures correlate with reduced verbal IQ in offspring.
- Most women achieving early seizure freedom maintain it throughout pregnancy.
Conclusions:
- Valproate poses significant risks during pregnancy, necessitating careful risk-benefit assessment.
- Maintaining seizure control is achievable for most women with epilepsy during pregnancy.
- Close monitoring and frequent therapeutic level assessment are crucial for lamotrigine and oxcarbazepine due to induced metabolism.
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