Document Detail


Antiepileptic drugs during pregnancy: what is known and which AEDs seem to be safest?
MedLine Citation:
PMID:  19087117     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Most infants born to women with epilepsy are healthy, but there are increased risks related to in utero antiepileptic drug (AED) exposure and seizures. Emerging data from pregnancy registries and other studies allow us to better balance the anatomic teratogenic and neurodevelopmental effects of AEDs against the need to maintain maternal seizure control. Several large prospective pregnancy registries demonstrate a consistent pattern of increased risk for major congenital malformations (MCMs) with valproate (VPA) use as monotherapy, compared to nonexposed populations and to other AEDs used in monotherapy. AED polytherapy likely increases risk for MCMs, but the risk is more pronounced if VPA is included. Reduced cognitive outcomes have been reported with AED polytherapy, and with use of VPA, phenobarbital (PB), and PHT as monotherapy. Dose-dependent risk has been demonstrated with VPA for MCMs and cognitive consequences. CBZ groups show normal neurodevelopment. Increased clearance of most of the AEDs occurs during pregnancy. Use of therapeutic drug monitoring during pregnancy with LTG reduces the risk for seizure worsening. The consistent findings of increased teratogenic risk for VPA should discourage use of this medication as first-line treatment in women of childbearing age.
Authors:
Page B Pennell
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Epilepsia     Volume:  49 Suppl 9     ISSN:  1528-1167     ISO Abbreviation:  Epilepsia     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-17     Completed Date:  2009-01-22     Revised Date:  2014-04-03    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  United States    
Other Details:
Languages:  eng     Pagination:  43-55     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Anticonvulsants / adverse effects*
Epilepsy / drug therapy*
Female
Humans
Pregnancy
Pregnancy Complications / drug therapy*
Grant Support
ID/Acronym/Agency:
P50 MH 68036/MH/NIMH NIH HHS; P50 MH068036/MH/NIMH NIH HHS; UL1 RR025008/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Anticonvulsants
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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