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Pregnancy registries: what do they mean to clinical practice?
Elizabeth Gerard1, Alison M Pack
1Neurological Institute, Columbia University, New York, NY 10032, USA.
Current Neurology and Neuroscience Reports
|July 2, 2008
Summary
Most women with epilepsy on antiepileptic drugs (AEDs) have healthy babies. However, valproate use, especially at higher doses, increases the risk of major congenital malformations.
Area of Science:
- Obstetrics and Gynecology
- Neurology
- Pharmacology
Background:
- Antiepileptic drugs (AEDs) are commonly prescribed during pregnancy for women with epilepsy.
- Surveillance pregnancy registries are crucial for monitoring AEDs' effects on fetal development.
- Concerns exist regarding the potential teratogenicity of AEDs.
Purpose of the Study:
- To synthesize findings from multiple surveillance pregnancy registries on AEDs and pregnancy outcomes.
- To assess the risk of major congenital malformations associated with AED exposure.
- To evaluate seizure control and other pregnancy-related data in women with epilepsy on AEDs.
Main Methods:
- Analysis of data from various hospital-based, population-based, and pharmaceutical-based pregnancy registries.
- Focus on major congenital malformations as the primary outcome variable.
- Varied methodologies across registries, including different populations, ascertainment, follow-up, and reporting criteria.
Main Results:
- The majority of pregnancies exposed to AEDs result in normal, healthy infant outcomes.
- Valproate, particularly at higher doses, demonstrates a statistically significant increased risk of major congenital malformations compared to other AEDs.
- Registry data provide insights into seizure control during pregnancy for women with epilepsy.
Conclusions:
- While most AEDs appear safe, valproate warrants careful consideration due to its association with higher malformation risks.
- The heterogeneity of registry methodologies limits direct comparative analyses.
- Continued surveillance is essential for refining understanding of AED safety in pregnancy.
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