Antiepileptic drug use during pregnancy: Perinatal outcomes

Kulaga, Sophie; Sheehy, Odile; Zargarzadeh, Amir H.; Moussally, Krystel; Bérard, Anick

doi:10.1016/j.seizure.2011.06.012

Cited by 36 publications

(27 citation statements)

References 34 publications

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“…Like our study, Kulaga et al 41 also found that the frequency of exposure to anticonvulsant mood stabilisers declined substantially during pregnancy, and in the second trimester was estimated to be 0.22% (95% CI 0.19 to 0.26%). 41 Most women were dispensed anticonvulsant mood stabilisers as monotherapy (79.6%) during pregnancy and the three most prevalent anticonvulsants were carbamazepine (29.9%), valproate (19.7%) and phenytoin (11.5%). 41 To our knowledge there are no recent estimates of lithium usage or prescribing in pregnancy.…”

Section: Psychotropic Medication Prescribed Before During and After supporting

confidence: 83%

“…Only between 21% and 25% had an indication of epilepsy. 40 A study by Kulaga et al 41 identified 349 epileptic pregnant women within the Quebec Pregnancy Registry and divided these into three groups based on maternal use of anticonvulsant mood stabilisers during pregnancy. Like our study, Kulaga et al 41 also found that the frequency of exposure to anticonvulsant mood stabilisers declined substantially during pregnancy, and in the second trimester was estimated to be 0.22% (95% CI 0.19 to 0.26%).…”

Section: Psychotropic Medication Prescribed Before During and After mentioning

confidence: 99%

“…40 A study by Kulaga et al 41 identified 349 epileptic pregnant women within the Quebec Pregnancy Registry and divided these into three groups based on maternal use of anticonvulsant mood stabilisers during pregnancy. Like our study, Kulaga et al 41 also found that the frequency of exposure to anticonvulsant mood stabilisers declined substantially during pregnancy, and in the second trimester was estimated to be 0.22% (95% CI 0.19 to 0.26%). 41 Most women were dispensed anticonvulsant mood stabilisers as monotherapy (79.6%) during pregnancy and the three most prevalent anticonvulsants were carbamazepine (29.9%), valproate (19.7%) and phenytoin (11.5%).…”

Section: Psychotropic Medication Prescribed Before During and After mentioning

confidence: 99%

“…41 Most women were dispensed anticonvulsant mood stabilisers as monotherapy (79.6%) during pregnancy and the three most prevalent anticonvulsants were carbamazepine (29.9%), valproate (19.7%) and phenytoin (11.5%). 41 To our knowledge there are no recent estimates of lithium usage or prescribing in pregnancy. However, the study by Reis and Källén 48 identified 79 lithium users among 958,729 pregnancies (< 0.01%) from the Swedish birth registry between July 1995 and the end of 2005.…”

Section: Psychotropic Medication Prescribed Before During and After mentioning

confidence: 99%

“…This has been the subject of a number of recent studies conducted in Europe and North America. [34][35][36][37][38][39][40][41] Epstein et al 39 examined use of psychotropic medication using data from Tennessee Medicaid to conduct a retrospective cohort study of nearly 300,000 women enrolled in the database throughout pregnancy from 1985 to 2005. This study reported significant increases in the use of anticonvulsants among mothers with pain and other psychiatric disorders, but a decrease in the use of lithium and typical antipsychotics.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

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BackgroundAlthough many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant.Objective(s)(1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy.DesignRetrospective cohort studies.SettingPrimary care.ParticipantsWomen treated for psychosis who became pregnant, and their children.InterventionsTreatment with antipsychotics, lithium or anticonvulsant mood stabilisers.Main outcome measuresDiscontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders.Data sourcesClinical Practice Research Datalink database and The Health Improvement Network primary care database.ResultsPrescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy.LimitationsA few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage.ConclusionsPsychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics.Future workFuture research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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Section: Psychotropic Medication Prescribed Before During and After supporting

confidence: 83%

Section: Psychotropic Medication Prescribed Before During and After mentioning

confidence: 99%

Section: Psychotropic Medication Prescribed Before During and After mentioning

confidence: 99%

Section: Psychotropic Medication Prescribed Before During and After mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

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Neuroteratology and Animal Modeling of Brain Disorders

Archer

Kostrzewa

2015

Current Topics in Behavioral Neurosciences

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Over the past 60 years, a large number of selective neurotoxins were discovered and developed, making it possible to animal-model a broad range of human neuropsychiatric and neurodevelopmental disorders. In this paper, we highlight those neurotoxins that are most commonly used as neuroteratologic agents, to either produce lifelong destruction of neurons of a particular phenotype, or a group of neurons linked by a specific class of transporter proteins (i.e., dopamine transporter) or body of receptors for a specific neurotransmitter (i.e., NMDA class of glutamate receptors). Actions of a range of neurotoxins are described: 6-hydroxydopamine (6-OHDA), 6-hydroxydopa, DSP-4, MPTP, methamphetamine, IgG-saporin, domoate, NMDA receptor antagonists, and valproate. Their neuroteratologic features are outlined, as well as those of nerve growth factor, epidermal growth factor, and that of stress. The value of each of these neurotoxins in animal modeling of human neurologic, neurodegenerative, and neuropsychiatric disorders is discussed in terms of the respective value as well as limitations of the derived animal model. Neuroteratologic agents have proven to be of immense importance for understanding how associated neural systems in human neural disorders may be better targeted by new therapeutic agents.

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Psychopharmacological Treatment of Mood and Anxiety Disorders During Pregnancy

Krüger

2012

Sex and Gender Differences in Pharmacology

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Many women with psychiatric disorders want to become mothers and only a minority seek advise prior to becoming pregnant. In those women, in whom pregnancy can be planned, the decision, if a medication is required for stabilisation and which one to choose if this is the case, is easier to make than in women in whom pregnancy occurs unplanned. The physician has to weigh the risk that a relapse of the psychiatric disorder during pregnancy poses to the foetus against the reproductive risk of psychotropic drugs. This presentation is intended to assist in understanding the general principles of pharmacotherapy during pregnancy as well as the morphological, perinatal and neurobehavioural toxicity of antidepressants, antipsychotics, benzodiazepines and mood stabilisers.

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Antiepileptic drug use during pregnancy: Perinatal outcomes

Cited by 36 publications

References 34 publications

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Neuroteratology and Animal Modeling of Brain Disorders

Psychopharmacological Treatment of Mood and Anxiety Disorders During Pregnancy

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