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Chapter 11 - Teratogenicity and Antiseizure Medications

Published online by Cambridge University Press:  19 December 2024

By
Anna Serafini
Edited by
Esther Bui  and
P. Emanuela Voinescu
Esther Bui
Affiliation:
Toronto Western Hospital
P. Emanuela Voinescu
Affiliation:
Brigham & Women's Hospital, Boston, MA
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Summary

Approximately one-half million women with epilepsy are of childbearing age in the United States, and three to five births per thousand will be to women with epilepsy. However, when considering indications for neuropathy, pain, and other neurological and psychiatric disorders, the total number of children exposed in utero to ASMs is considerably greater. The goal during pregnancy is to keep a balance between seizure control and the potential teratogenic risks of antiseizure medications (ASMs). It is always important to remind patients that over 96% of pregnancies in WWE have good outcomes. The teratogenic effects of ASMs vary based on the specific moment of exposure during pregnancy. ASMs exposures during the embryonic phase of pregnancy leads to congenital malformations. Based on the exact week and the specific drug used, different malformations affecting different organs are seen. Exposures that last throughout the entire pregnancy can affect cognitive and behavioral development. Pregnancy registries have been developed all over the world to better understand the effects of ASMs. Studies on cognitive and behavioral development are more laborious and fewer. Overall studies agree on the fact that Valproate acid (VPA) the most teratogenic ASM as it pertains to major congenital malformations and cognitive and behavioral issues as well. Those effects seem to be dose dependent. VPA should be avoided in women of childbearing age when possible. ASMs with better teratogenic profile are lamotrigine and levetiracetam. More data on newer ASMs are still needed to assess their safety in pregnancy. The use of folic acid is recommended in WWE. It reduces the risks of malformations and recent studies have confirmed its positive effect on cognitive and behavioral development.

Type
Chapter
Information
Women with Epilepsy
A Practical Management Handbook
 , pp. 191 - 214
Publisher: Cambridge University Press
Print publication year: 2025

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