Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade

Abstract

Management of seizures often involves continuous medication use throughout a patient’s life, including when a patient is pregnant. The physiological changes during pregnancy can lead to altered drug exposure to anti-seizure medications, increasing patient response variability. In addition, subtherapeutic anti-seizure medication concentrations in the mother may increase seizure frequency, raising the risk of miscarriage and preterm labor. On the other hand, drug exposure increases can lead to differences in neurodevelopmental outcomes in the developing fetus. Established pregnancy registries provide insight into the teratogenicity potential of anti-seizure medication use. In addition, some anti-seizure medications are associated with an increased risk of major congenital malformations, and their use has declined over the last decade. Although newer anti-seizure medications are thought to have more favorable pharmacokinetics in general, they are not without risk, as they may undergo significant pharmacokinetic changes when an individual becomes pregnant. With known changes in metabolism and kidney function during pregnancy, therapeutic monitoring of drug concentrations helps to determine if and when doses should be changed to maintain similar seizure control as observed pre-pregnancy. This review concentrates on the results from research in the past decade (2010–2022) regarding risks of major congenital malformations, changes in prescribing patterns, and pharmacokinetics of the anti-seizure medications that are prescribed to pregnant patients with epilepsy.

Abordaje de la epilepsia en el periodo gestacional, una interacción que requiere de medicina basada en evidencia

“…El valproato se asocia con el mayor riesgo de malformaciones, así como con resultados cognitivos y conductuales adversos, y debe evitarse, siempre que sea posible, en el tratamiento de pacientes que puedan quedar embarazadas. La lamotrigina y el levetiracetam se asocian con el riesgo más bajo de malformaciones, pero los datos sobre el desarrollo neurológico para el levetiracetam se basan en una muestra pequeña y faltan pruebas sobre los efectos de la exposición prenatal en el desarrollo neurológico o son insuficientes para otros FAE de nueva generación (Avachat et al, 2022).…”

Beneficial Impact of Aerobic Exercise During Pregnancy on Motor Coordination Deficits Induced by PTZ in Preadolescent Male Mice

“…There are concerns regarding the safety of AEDs during pregnancy due to the increased risk of adverse birth outcomes and neurodevelopmental disorders in children exposed to these medications [9][10][11]. Research has shown a higher likelihood of congenital malformations in children of women with epilepsy who take AEDs during pregnancy, with common malformations including heart defects, orofacial clefts, skeletal deformities, urological abnormalities, and neural tube defects [12,13].…”