Levetiracetam use in pregnancy

Area of Science:

• Obstetrics and Gynecology
• Neurology
• Pharmacology

Background:

• Epilepsy management during pregnancy requires careful consideration of antiepileptic drugs (AEDs).
• Levetiracetam is a commonly used AED, but its safety profile in pregnancy needs thorough evaluation.
• Understanding pharmacokinetic changes and teratogenic potential is crucial for optimizing treatment.

Purpose of the Study:

• To review existing data on the management of epilepsy with levetiracetam during pregnancy.
• To assess pharmacokinetic alterations, teratogenic risks, and recommended monitoring strategies.

Main Methods:

• A comprehensive literature search of PubMed was conducted using relevant keywords.
• Included studies were those published in English, involving human subjects, and reporting on levetiracetam use in pregnancy.
• Bibliographies of retrieved articles were reviewed for additional relevant studies.

Main Results:

• Levetiracetam clearance significantly increases during pregnancy, especially in the third trimester, leading to reduced serum concentrations.
• Teratogenic studies involving 147 patients showed a low incidence of major (2%) and minor (4.8%) congenital anomalies, with all affected patients on AED polytherapy.
• Limited data exists on levetiracetam monotherapy, adherence, and folic acid supplementation in this population.

Conclusions:

• Levetiracetam use in pregnancy necessitates adequate folic acid supplementation (0.4-5 mg/day).
• Regular monitoring of levetiracetam serum concentrations is recommended throughout pregnancy, particularly in the third trimester.
• Dose adjustments may be required to maintain therapeutic levels, and patients should be informed about the limited data on malformation risks.