Management of epilepsy during pregnancy

Expert Review of Neurotherapeutics

Volumn 15, Issue 10, 2015, Pages 1171-1187

  Voinescu, P Emanuela ^a   Pennell, Page B ^a  

^a HARVARD MEDICAL SCHOOL   (United States)

Author keywords

antiepileptic drugs; epilepsy; major congenital malformations; neonatal complications; neurodevelopmental outcome; pregnancy

Indexed keywords

ANTICONVULSIVE AGENT; BROMIDE; CARBAMAZEPINE; CLOBAZAM; CYTOCHROME P450 2C19; CYTOCHROME P450 2E1; CYTOCHROME P450 3A4; ESLICARBAZEPINE; ETHOSUXIMIDE; ETIRACETAM; FELBAMATE; GABAPENTIN; HARKOSERIDE; LAMOTRIGINE; ORAL CONTRACEPTIVE AGENT; OXCARBAZEPINE; PERAMPANEL; PHENOBARBITAL; PHENYTOIN; PREGABALIN; PRIMIDONE; RETIGABINE; RUFINAMIDE; STIRIPENTOL; TIAGABINE; TOPIRAMATE; VALPROIC ACID; VIGABATRIN; ZONISAMIDE;

AUTISM; CENTRAL NERVOUS SYSTEM MALFORMATION; CLEFT LIP; CLEFT PALATE; CLINICAL RESEARCH; CLONIC SEIZURE; CONGENITAL MALFORMATION; DRUG BIOAVAILABILITY; DRUG BLOOD LEVEL; DRUG EFFICACY; DRUG MONITORING; EPILEPSY; FETAL HYDANTOIN SYNDROME; FETUS DEVELOPMENT; FETUS MALFORMATION; FETUS RISK; FIRST TRIMESTER PREGNANCY; HEART VENTRICLE SEPTUM DEFECT; HUMAN; INTELLIGENCE; LANGUAGE ABILITY; MATERNAL MORTALITY; MONOTHERAPY; OUTCOME ASSESSMENT; PREGNANCY; PREGNANT WOMAN; PREMATURE LABOR; REVIEW; RISK FACTOR; SEIZURE; SEIZURE THRESHOLD; TONIC CLONIC SEIZURE; FEMALE; PATHOPHYSIOLOGY; PREGNANCY COMPLICATIONS;

ANTICONVULSANTS; EPILEPSY; FEMALE; HUMANS; PREGNANCY; PREGNANCY COMPLICATIONS;

EID: 84942980897     PISSN: 14737175     EISSN: 17448360     Source Type: Journal    
DOI: 10.1586/14737175.2015.1083422     Document Type: Review

References (64)

1. Adedinsewo D, Thurman D, Luo Y, et al. Valproate prescriptions for nonepilepsy disorders in reproductive-age women. Birth Defects Res A Clin Mol Teratol 2013; 97 (6): 403-8
2. Tomson T, Battino D, Bonizzoni E, et al. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurology 2011; 10 (7): 609-17
3. Hernández-Díaz S, Smith CR, Shen A, et al. Comparative safety of antiepileptic drugs during pregnancy. Neurology 2012; 78 (21): 1692-9
4. Harden CL, Hopp J, Ting TY, et al. Practice Parameter update: Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): Obstetrical complications and change in seizure frequency report of the quality standards subcommittee and therapeutics and technology assessment subcommittee of the american academy of neurology and american epilepsy society. Neurology 2009; 73 (2): 126-32
5. Battino D, Tomson T, Bonizzoni E, et al. Seizure control and treatment changes in pregnancy: Observations from the EURAP epilepsy pregnancy registry. Epilepsia 2013; 54 (9): 1621-7
6. Neve A, Boero G, Francavilla T, et al. Prospective, case-control study on the effect of pregnancy on seizure frequency in women with epilepsy. Neurol Sci 2014; 36 (1): 7983
7. Thomas S, Syam U, Devi S. Predictors of seizures during pregnancy in women with epilepsy. Epilepsia 2012; 53 (5): e85-8
8. Vajda FJ, OBrien TJ, Graham J, et al. The outcomes of pregnancy in women with untreated epilepsy. Seizure 2015; 24: 7781
9. Pennell P. Pregnancy, epilepsy, and womens issues. Continuum (Minneapolis, Minn) 2013; 19 (3 Epilepsy): 697-714
10. Tomson T, Landmark C, Battino D. Antiepileptic drug treatment in pregnancy: Changes in drug disposition and their clinical implications. Epilepsia 2013; 54 (3): 405-14
11. McGrath A, Sharpe L, Lah S, Parratt K. Pregnancy-related knowledge and information needs of women with epilepsy: A systematic review. Epilepsy & Behavior 2014; 31: 246255
12. Harden CL, Meador KJ, Pennell PB, et al. Practice Parameter update: Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes report of the quality standards subcommittee and therapeutics and technology assessment subcommittee of the american academy of neurology and american epilepsy society. Neurology 2009; 73 (2): 133-41
13. Teramo K, Hiilesmaa V, Bardy A, Saarikoski S. Fetal heart rate during a maternal grand mal epileptic seizure. J Perinat Med 1978; 7 (1): 3-6
14. Adab N, Kini U, Vinten J, et al. The longer term outcome of children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry 2004; 75 (11): 1575-83
15. Edey S, Moran N, Nashef L. SUDEP and epilepsy-related mortality in pregnancy. Epilepsia 2014; 55 (7): e72-4
16. Baker G, Bromley R, Briggs M, et al. IQ at 6 years after in utero exposure to antiepileptic drugs: a controlled cohort study. Neurology 2015; 84 (4): 382-90
17. Pennell PB, Klein AM, Browning N, et al. Differential effects of antiepileptic drugs on neonatal outcomes. Epilepsy & behavior: E&B 2012; 24 (4): 449-56
18. Campbell E, Devenney E, Morrow J, et al. Recurrence risk of congenital malformations in infants exposed to antiepileptic drugs in utero. Epilepsia 2012; 54 (1): 165-71
19. Vajda F, OBrien T, Lander C, et al. Teratogenesis in repeated pregnancies in antiepileptic drug-treated women. Epilepsia 2012; 54 (1): 181-6
20. Meador K, Baker G, Browning N, et al. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurology 2013; 12 (3): 244-52
21. Meador K, Baker G, Browning N, et al. Cognitive Function at 3 Years of Age after Fetal Exposure to Antiepileptic Drugs. N Engl J Med 2009; 360 (16): 1597-605
22. Meador KJ, Baker GA, Browning N, et al. Effects of fetal antiepileptic drug exposure: outcomes at age 4.5 years. Neurology 2012; 78 (16): 1207-14
23. Bromley RL, Mawer GE, Briggs M, et al. The prevalence of neurodevelopmental disorders in children prenatally exposed to antiepileptic drugs. J Neurol Neurosurg Psychiatr 2013; 84 (6): 637-43
24. Veiby G, Daltveit A, Schjølberg S, et al. Exposure to antiepileptic drugs in utero and child development: a prospective population-based study. Epilepsia 2013; 54 (8): 1462-72
25. Shallcross R, Bromley RL, Irwin B, et al. Child development following in utero exposure: levetiracetam vs sodium valproate. Neurology 2011; 76 (4): 383-9
26. Shallcross R, Bromley RL, Cheyne CP, et al. In utero exposure to levetiracetam vs valproate: development and language at 3 years of age. Neurology 2014; 82 (3): 213-21
27. Nadebaum C, Anderson VA, Vajda F, et al. Language skills of school-aged children prenatally exposed to antiepileptic drugs. Neurology 2011; 76 (8): 719-26
28. Reisinger TL, Newman M, Loring DW, et al. Antiepileptic drug clearance and seizure frequency during pregnancy in women with epilepsy. Epilepsy & behavior: E&B 2013; 29 (1): 13-18
29. Tomson T, Battino D. Teratogenic effects of antiepileptic drugs. Lancet Neurol 2012; 11 (9): 803-13
30. Reinisch JM, Sanders SA, Mortensen EL, Rubin DB. In utero exposure to phenobarbital and intelligence deficits in adult men. JAMA 1995; 274 (19): 1518-25
31. Bromley R, Weston J, Adab N, et al. Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child. Cochrane Database Systemat Rev 2013; 10: CD010236
32. Vajda F, OBrien T, Lander C, et al. The efficacy of the newer antiepileptic drugs in controlling seizures in pregnancy. Epilepsia 2014; 55 (8): 1229-34
33. Vajda FJ, OBrien TJ, Lander CM. The teratogenicity of the newer antiepileptic drugs-an update. Acta Neurol Scand 2014; 130 (4): 234-8
34. Campbell E, Kennedy F, Russell A, et al. Malformation risks of antiepileptic drug monotherapies in pregnancy: updated results from the UK and Ireland Epilepsy and Pregnancy Registers. J Neurol Neurosurg Psychiatry 2014; 85 (9): 1029-34
35. Veiby G, Daltveit A, Engelsen B, Gilhus N. Fetal growth restriction and birth defects with newer and older antiepileptic drugs during pregnancy. J Neurol 2014; 261 (3): 579-88
36. Artama M, Gissler M, Malm H, et al. Effects of maternal epilepsy and antiepileptic drug use during pregnancy on perinatal health in offspring: nationwide, retrospective cohort study in Finland. Drug Saf 2013; 36 (5): 359369
37. Johnson E, Stowe Z, Ritchie J, et al. Carbamazepine clearance and seizure stability during pregnancy. Epilepsy & Behavior 2014; 33: 4953
38. Marson A, Al-Kharusi A, Alwaidh M, et al. The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial. Lancet 2007; 369 (9566): 1016-26
39. U.S. Food and Drug Administration. FDA drug safety communication: valproate anti-seizure products contraindicated for migraine prevention in pregnant women due to decreased IQ scores in exposed children. 2013. [Epub ahead of print]
40. Unknown. PRAC recommends restricting valproate. Reactions Weekly 2014; 1524 (1): 4
41. Jentink J, Loane M, Dolk H, et al. Valproic acid monotherapy in pregnancy and major congenital malformations. N Engl J Med 2010; 362 (23): 2185-93
42. Kilic D, Pedersen H, Kjaersgaard M, et al. Birth outcomes after prenatal exposure to antiepileptic drugs-A population-based study. Epilepsia 2014; 55 (11): 1714-21
43. Christensen J, Grønborg T, Sørensen M, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA 2013; 309 (16): 1696-703
44. Mølgaard-Nielsen D, Hviid A. Newer-generation antiepileptic drugs and the risk of major birth defects. JAMA 2011; 305 (19): 1996-2002
45. Artama M, Auvinen A, Raudaskoski T, et al. Antiepileptic drug use of women with epilepsy and congenital malformations in offspring. Neurology 2005; 64 (11): 1874-8
46. Reimers A, Brodtkorb E. Second-generation antiepileptic drugs and pregnancy: a guide for clinicians. Expert Rev Neurother 2012; 12 (6): 707-17
47. Group E. Seizure control and treatment in pregnancy: observations from the EURAP epilepsy pregnancy registry. Neurology 2006; 66 (3): 354-60
48. Polepally A, Pennell P, Brundage R, et al. Model-based lamotrigine clearance changes during pregnancy: clinical implication. Annals of Clinical and Translational Neurology 2014; 1 (2): 99-106
49. Pennell PB, Peng L, Newport DJ, et al. Lamotrigine in pregnancy: Clearance, therapeutic drug monitoring, and seizure frequency. Neurology 2007; 70 (22 Pt 2): 2130-6
50. Morrow J, Russell A, Guthrie E, et al. Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatr 2006; 77 (2): 193-8
51. Montouris G. Gabapentin exposure in human pregnancy: results from the Gabapentin Pregnancy Registry. Epilepsy & behavior: E&B 2003; 4 (3): 310-17
52. Fujii H, Goel A, Bernard N, et al. Pregnancy outcomes following gabapentin use: results of a prospective comparative cohort study. Neurology 2013; 80 (17): 1565-70
53. Öhman I, Vitols S, Tomson T. Pharmacokinetics of gabapentin during delivery, in the neonatal period, and lactation: does a fetal accumulation occur during pregnancy? Epilepsia 2005; 46 (10): 1621-4
54. Mines D, Tennis P, Curkendall S, et al. Topiramate use in pregnancy and the birth prevalence of oral clefts. Pharmacoepidemiol Drug Saf 2014; 23 (10): 1017-25
55. Margulis A, Mitchell A, Gilboa S, et al. Use of topiramate in pregnancy and risk of oral clefts. Am J Obstetr Gynecol 2012; 207 (5): 405.e1-7
56. Hernández-Díaz S, Mittendorf R, Smith C, et al. Association between topiramate and zonisamide use during pregnancy and low birth weight. Obstetr Gynecol 2014; 123 (1): 21
57. Rihtman T, Parush S, Ornoy A. Preliminary findings of the developmental effects of in utero exposure to topiramate. Reproduct Toxicol (Elmsford, NY) 2012; 34 (3): 308-11
58. Holmes L, Hernández-Díaz S. Newer anticonvulsants: lamotrigine, topiramate and gabapentin. Birth Defects Res A Clin Mol Teratol 2012; 94 (8): 599-606
59. Mawhinney E, Craig J, Morrow J, et al. Levetiracetam in pregnancy: results from the UK and Ireland epilepsy and pregnancy registers. Neurology 2013; 80 (4): 400-5
60. Chaudhry S, Jong G, Koren G. The fetal safety of Levetiracetam: a systematic review. Reproductive toxicology (Elmsford, N.Y.) 2014; 46: 40-5
61. Rektor I, Krauss GL, Bar M, et al. Perampanel Study 207: long-term open-label evaluation in patients with epilepsy. Acta Neurol Scand 2012; 126 (4): 263-9
62. Vajda F, Hitchcock A, Graham J, et al. The teratogenic risk of antiepileptic drug polytherapy. Epilepsia 2010; 51 (5): 805-10
63. Holmes L, Mittendorf R, Shen A, et al. Fetal effects of anticonvulsant polytherapies: different risks from different drug combinations. Arch Neurol 2011; 68 (10): 1275-81
64. Forsberg L, Wide K, Källén B. School performance at age 16 in children exposed to antiepileptic drugs in utero - a population-based study. Epilepsia 2011; 52 (2): 364-9