Anti-epileptic drug and folic acid usage during pregnancy, seizure and malformation outcomes: Changes over two decades in the Kerala Registry of Epilepsy and Pregnancy

Keni, Ravish R.; Jose, Manna; Reshma, A; Baishya, Jitupam; Sarma, P. Sankara; Thomas, Sanjeev V

doi:10.1016/j.eplepsyres.2019.106250

Cited by 19 publications

(27 citation statements)

References 20 publications

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“…There is a strong association (drug and dosage) of anti-epileptic drugs (AEDs) with increased congenital anomalies (prevalence 2.5%) including neural tube defects. There has been no impact on the congenital anomaly prevalence with ‘high dose’ FA supplementation in epileptic pregnancy care ( Harden, 2014 , Keni et al, 2020 , Baishya et al, 2020 , Kashif et al, 2019 , Harden et al, 2009 , Harden et al, 2009 , Morrow et al, 2009 , Kjaer et al, 2008 , Tomson et al, 2015 , Herzog et al, 2017 , Mahdavi et al, 2019 ) as the AEDs teratogenic mechanism may have no FA component or association ( Harden et al, 2009 , Harden et al, 2009 , Morrow et al, 2009 ). H igh dose FA should no longer be recommended for congenital anomaly reduction for pregnant women with epilepsy ( Stephen et al, 2019 , Tomson et al, 2020 , Li et al, 2021 ).…”

Section: Resultsmentioning

confidence: 99%

Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects

Wilson

O'Connor

2021

Preventive Medicine Reports

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More evidence is available for maternal intake, absorption, distribution, tissue specific concentrations, and pregnancy outcomes with folic acid (fortification/supplementation) during preconception – first trimester. This Quality Improvement prevention review used expert guidelines/opinions, systematic reviews, randomized control trials/controlled clinical trials, and observational case control/case series studies, published in English, from 1990 to August 2021. Optimization for an oral maternal folic acid supplementation is difficult because it relies on folic acid dose, type of folate supplement, bio-availability of the folate from foods, timing of supplementation initiation, maternal metabolism/genetic factors, and many other factors. There is continued use of high dose pre-food fortification ‘RCT evidenced-based’ folic acid supplementation for NTD recurrence pregnancy prevention. Innovation requires preconception and pregnancy use of ‘carbon one nutrient’ supplements (folic acid, vitamin B12, B6, choline), using the appropriate evidence, need to be considered. The consideration and adoption of directed personalized approaches for maternal complex risk could use serum folate testing for supplementation dosing choice. Routine daily folic acid dosing for low-risk women should consider a multivitamin with 0.4 mg of folic acid starting 3 months prior to conception until completion of breastfeeding. Routine folic acid dosing or preconception measurement of maternal serum folate (after 4–6 weeks of folate supplementation) could be considered for maternal complex risk group with genetic/medical/surgical co-morbidities. These new approaches for folic acid oral supplementation are required to optimize benefit (decreasing folate sensitive congenital anomalies; childhood morbidity) and minimizing potential maternal and childhood risk.

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Section: Resultsmentioning

confidence: 99%

Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects

Wilson

O'Connor

2021

Preventive Medicine Reports

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“…During the audit period, a substantial proportion (17.75%) of pregnancies were exposed to VPA, although this proportion had been shrinking. 6,21,22,24,25 The risk of seizure exacerbation when VPA is replaced by alternative AEDs 26 is a major reason for continuing its use despite its teratogenic potential.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, VPA and other older AEDs are widely used in India and other low and middle income countries. 24 We carried out this audit to study the pattern of VPA usage in women during pregnancy and the possible reasons for its continued use.…”

Section: Introductionmentioning

confidence: 99%

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Valproate usage in pregnancy: An audit from the Kerala Registry of Epilepsy and Pregnancy

et al. 2021

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Objective: This is an audit of the use of valproate (VPA) during pregnancy in women with epilepsy (WWE). Methods: We identified all pregnancies exposed to VPA in the Kerala Registry of Epilepsy and Pregnancy between January 2010 and December 2019. Subjects' past usage of antiepileptic drugs (AEDs), seizure count before and during pregnancy, fetal outcome, and major congenital malformations (MCMs) were abstracted from the registry records. The presumed reason for usage of VPA was deducted from the clinical records. Results: There were 221 pregnancies (17.

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“…Nevertheless, no definite data exist and further studies are required to determine the most effective and safe dose of folic acid in WWE. But there is actually a consensus to recommend a preconceptional and conceptional folic acid supplementation in WWE [32]. Unfortunately, recent studies still demonstrate a low prevalence of preconception folic acid use that may, once again, reflect a need for more education [28].…”

Section: Folatesmentioning

confidence: 99%

Epilepsy and pregnancy: What should the neurologists do?

Vercueil

2021

Revue Neurologique

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Epilepsy is one of the most common chronic disorders affecting women of childbearing age. Unfortunately, many women with epilepsy (WWE) still report not receiving key information about pregnancy. They obviously need information about epilepsy and pregnancy prior to conception with a particular emphasis on effective birth control (i.e contraception), necessity to plan pregnancy, antiepileptic drugs optimization, and folate supplementation. The risks associated with use of antiepileptic drugs during pregnancy has to be balanced against fetal and maternal risks associated with uncontrolled seizures. This report reviews evidence-based counseling and management strategies concerning maternal and fetal risks associated with seizures, teratogenic risks associated with antiepileptic drug exposure with a special emphasis on developmental and behavioural outcomes of children exposed to intra utero antiepileptic drugs.

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Anti-epileptic drug and folic acid usage during pregnancy, seizure and malformation outcomes: Changes over two decades in the Kerala Registry of Epilepsy and Pregnancy

Cited by 19 publications

References 20 publications

Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects

Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects

Valproate usage in pregnancy: An audit from the Kerala Registry of Epilepsy and Pregnancy

Epilepsy and pregnancy: What should the neurologists do?

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