Related Experiment Video
Updated: Aug 2, 2025
Electrophoretic Delivery of γ-aminobutyric Acid GABA into Epileptic Focus Prevents Seizures in Mice
Published on: May 16, 2019
Antiseizure medication use during pregnancy and neonatal growth outcomes: A systematic review and meta-analysis
Alekhya Lavu1, Christine Vaccaro1, Enav Zusman2
1College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Antiseizure medication (ASM) use in pregnancy is linked to higher risks of small for gestational age (SGA) and low birth weight (LBW) neonates. Polytherapy with ASMs increases these risks further compared to monotherapy.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Pharmacology
Background:
- Antiseizure medications (ASMs) are frequently prescribed during pregnancy.
- Understanding the impact of ASMs on fetal growth is crucial for informed clinical decision-making.
- Existing literature on neonatal growth outcomes requires systematic synthesis.
Purpose of the Study:
- To systematically review and synthesize published data on neonatal growth outcomes in infants exposed to ASMs during pregnancy.
- To quantify the risks of small for gestational age (SGA) and low birth weight (LBW) associated with prenatal ASM exposure.
- To explore risks related to birth weight, height, and head circumference, and conduct subgroup analyses based on ASM class, epilepsy type, and polytherapy versus monotherapy.
Main Methods:
- A systematic literature search was conducted across seven databases up to March 23, 2022.
- Included studies compared neonatal outcomes of pregnant individuals exposed to ASMs versus unexposed individuals.
- Primary outcomes were SGA and LBW; secondary outcomes included birth weight, height, cephalization index, and head circumference. Subgroup analyses examined ASM class, epilepsy type, and polytherapy vs. monotherapy.
Main Results:
- The review included 65 studies from 15,720 screened citations.
- Prenatal ASM exposure was associated with significantly increased risks of SGA (RR 1.33) and LBW (RR 1.54), and decreased birth weight (MD -118.87 g).
- Subgroup analyses indicated that ASM polytherapy, within epilepsy groups, and specific ASM classes were also linked to increased SGA and LBW risks.
Conclusions:
- This meta-analysis confirms that prenatal exposure to ASMs significantly increases the risk of adverse fetal growth outcomes, including SGA and LBW, and reduced birth weight.
- ASM polytherapy presents a higher risk of adverse growth outcomes compared to monotherapy.
- Further research is needed to elucidate the specific risks associated with individual ASMs during pregnancy.
Aims:
We aimed to systematically synthesize the current published literature on neonatal growth outcomes associated with antiseizure medication (ASM) use during pregnancy.
Methods:
We searched seven databases, from inception to 23 March 2022. We investigated small for gestational age (SGA) and low birth weight (LBW) as primary outcomes and birth weight, birth height, cephalization index and head circumference as secondary outcomes. The primary analysis included pregnant people exposed to any ASM compared with unexposed pregnant people. Subgroup analysis included ASM class analysis, within epilepsy group analysis and polytherapy compared to monotherapy.
Results:
We screened 15 720 citations and included 65 studies in the review. Exposed pregnant people had a significantly increased risk of SGA relative risk (RR) 1.33 (95% CI 1.18 to 1.50, I2 74%), LBW RR 1.54 (95% CI 1.33 to 1.77, I2 67%), and decreased birth weight with a mean difference (MD) of -118.87 (95% CI -161.03 to -76.71, I2 42%) g. A non-significant risk change in birth height and head circumference was observed. In subgroup analysis, ASM polytherapy, within epilepsy and ASM class analysis were also associated with an increased risk of SGA and LBW.
Conclusions:
This meta-analysis demonstrates that pregnant people exposed to ASMs have a significantly increased risk of adverse fetal growth outcomes including SGA and LBW and decreased birth weight compared to unexposed pregnant people. Polytherapy was associated with higher risks compared to monotherapy. Additional studies are warranted on specific ASM risks.
Related Concept Videos
01:18Antiepileptic Drugs: GABAergic Pathway Potentiators
The key GABA pathway potentiators used in epilepsy management are as follows.
Benzodiazepines are a well-known class of drugs used for...
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:17Antiepileptic Drugs: Calcium Channel Blockers
Calcium channel blockers exert their antiepileptic effects by targeting T-type calcium channels, which are integral to transmitting nerve signals in the central nervous system. These channels allow the passage of calcium ions, which are vital for neuronal communication. By inhibiting T-type calcium channels, calcium channel blockers effectively reduce the release of neurotransmitters and...
01:20Antiepileptic Drugs: Potassium Channel Activators
Ezogabine has gained approval as an adjunctive treatment...
01:08Antiepileptic Drugs: Sodium Channel Blockers
Sodium channel blockers modulate ion channels, particularly voltage-gated sodium channels. They block only sodium ion movement.
Among the most commonly prescribed antiepileptic drugs are...
01:14Antiepileptic Drugs: Glutamate Antagonists