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Safety of Antiepileptic Drugs During Pregnancy

Safety of Antiepileptic Drugs During Pregnancy

A study investigated the association between maternal epilepsy, antiepileptic drugs used during pregnancy, and perinatal outcomes since there is little data comparing perinatal outcomes with or without antiepileptic drug use during pregnancy.

Epilepsy is a chronic disorder marked by unpredictable, recurring seizures caused by disruptions in nerve cell activity in the brain.  During a seizure, any brain function can be affected.  Once diagnosed, people usually begin treatment with antiepileptic drugs (AEDs) to reduce the number and duration of their seizures.  However, other health problems such as depression, insomnia, stomach upset, osteoporosis, or eye damage seem to be more prevalent amongst epileptics and it is unknown whether these are related to the disease, the medications, or both.  The result is that, even with medication, epilepsy can still have a negative impact on not just the individual’s safety, but often their ability to drive, work or attend school, and socialize too.
In women, epilepsy can affect hormonal and menstrual cycles. While 90% of women with epilepsy become pregnant and deliver healthy babies, it is strongly advised that women discuss their AEDs with their neurologist and obstetrician before conceiving since there is little data comparing perinatal outcomes with or without AED use during pregnancy.

In a study published in JAMA Neurology, researchers from Sweden investigated the associations between maternal epilepsy, AED use during pregnancy, and perinatal outcomes.  Their population-based cohort study included more than 1.4 million (single child) births between 1997 and 2011; however, information on AED exposure was only available from July 1, 2005.  The sample contained 5,373 births to 3,586 women with epilepsy.  After controlling for maternal age, country of origin, educational level, cohabitation with a partner, height, weight, smoking behaviour, and year of delivery, multivariate linear regression was used to estimate adjusted risk ratios for diabetes, high blood pressure, and mood disorders.
Although a diagnosis of epilepsy implies moderately increased risks during pregnancy, this study found that AED use during pregnancy was not associated with adverse maternal, fetal, or neonatal outcomes.  This information should improve counseling for women with epilepsy who contemplate discontinuing their treatment during pregnancy and provide useful information to their health care clinicians.

Written by Debra A. Kellen, PhD

Citation:  Razaz N, Tomson T, Wikström A, Cnattingius S. Association Between Pregnancy and Perinatal Outcomes Among Women with Epilepsy. JAMA Neurol. Published online July 03, 2017. doi:10.1001/jamaneurol.2017.1310

Source: Medical News Bulletin

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