No abstract

The Australian Pregnancy Registry, affiliated European Register of Antiepileptic drugs in Pregnancy (EURAP), recruits informed consenting women with epilepsy on treatment with antiepileptic drugs (AEDs), those untreated, and women on AEDs for other indications. Enrolment is considered prospective if it has occurred before presence or absence of major foetal malformations (FMs) are known, or retrospective, if they had occurred after the birth of infant or detection of major FM. Telephone Interviews are conducted to ascertain pregnancy outcome and collect data about seizures. To date 630 women have been enrolled, with 565 known pregnancy outcomes. Valproate (VPA) above 1100 mg/day was associated with a significantly higher incidence of FMs than other AEDs (P < 0.05). This was independent of other AED use or potentially confounding factors on multivariate analysis (OR = 7.3, P < 0.0001). Lamotrigine (LTG) monotherapy (n = 65), has so far been free of malformations. Although seizure control was not a primary outcome, we noted that more patients on LTG than on VPA required dose adjustments to control seizures. Data indicate an increased risk of FM in women taking VPA in doses >1100 mg/day compared with other AEDs. The choice of AED for pregnant women with epilepsy requires assessment of balance of risks between teratogenicity and seizure control.

The Register has already produced important information for the management of pregnant women with epilepsy in Australia, but greater rates of recruitment into the Register are desirable to allow it to achieve its full potential.

No abstract

Several publications have reported an increased risk of fetal malformation in the offspring of mothers who during pregnancy took more than one antiepileptic drug (AED) simultaneously as compared to those taking AED monotherapy (Tanganelli & Regesta, 1992;Olafsson et al., 1998;Arpino et al., 2000;Lowe, 2001;Hart, 2003;Morrow & Craig, 2003;Pack, 2006). A similar increased risk in patients taking polytherapy was not found in an earlier analysis of data from the Australian Register of AEDs in Pregnancy (Vajda et al., 2003). Here we have specifically reexamined the issue of the relative teratogenic risk of AED polytherapy in the larger cohort of women now enrolled on the register, with particular attention to the nature and dose of the drugs taken. Materials and Methods Analysis of data from the Australian Pregnancy RegisterThe Australian Register of Antiepileptic Drugs in Pregnancy has been collecting data concerning the use of AEDs in pregnant women since 1999. Recruitment is nationwide and voluntary, and contact with the register is by telephone. Potentially eligible women are informed about the register by a variety of methods, but most commonly by their treating medical practitioners, nurses, or allied health professionals, or by other pregnant women. Relevant details are obtained from pregnant women on recruitment (usually in the first or second trimester), at 7 months of pregnancy, in the first postnatal month, and at the end of the first postnatal year. Treating doctors are contacted to confirm medical details. Fetal malformations are classified according to the Birth Defects Registry of Victoria (Riley & Haliday, 1988). The register database was housed initially at St Vincent's Hospital, Melbourne, and subsequently at Monash University, Melbourne, and has been under the consecutive ethical oversight of the ethics committees of these institutions.For the purposes of this analysis the incidence of the malformations was determined on the basis of all information available at the end of the first postnatal month and the first postnatal year. The 1-year data were used for all analyses except for comparisons with the international literature, for which the 1-month data were also used.The data relevant to the present article were extracted from the register's Microsoft Access database into an Excel spreadsheet and then analyzed by confidence interval (CI)

No abstract

Treatment is not interfered with. Data are analysed using conventional statistical techniques, confidence interval methods, and logistic regression. Results: By 2018, the APR contained details of 2148 pregnancies. AEDs were taken throughout 1972 of the pregnancies (91.8%). The remaining 176 (8.2%) did not receive AEDs, at least early in pregnancy.There were (i) dose-related increased incidences of pregnancies carrying foetal malformations associated with maternal intake of valproate and topiramate when topiramate was a component of AED polytherapy (P < .05), (ii) a similar dose-related trend in relation to carbamazepine intake, (iii) no evidence that levetiracetam and lamotrigine were unsafe from the foetal standpoint, (iv) insufficient data to permit conclusions regarding teratogenicity in relation to other AEDs, and (v) no evidence that pre-conception folate supplementation reduced the hazard of AED-associated foetal malformation. AED polytherapy did not increase foetal hazard unless valproate or topiramate was involved in the AED combination. Genetic factors probably contributed to the malformation hazard. Seizures occurring in earlier pregnancy probably did not contribute to the malformation hazard. Conclusions: If it were not for the importance of maintaining seizure control, the above findings suggest that it would be better to avoid using certain AEDs, particularly valproate and topiramate, during pregnancy.

While otherwise following national AED prescribing trends, Australian prescribers are reducing the use and dose of valproate in pregnant women, likely in recognition of the teratogenic hazards of this drug.