Common antiepileptic drugs in pregnancy in women with epilepsy

Adab, Naghme; Smith, Catrin Tudur; Vinten, Jacqui; Williamson, Paula; Winterbottom, Janine B; McKay, A. J.; Bromley, Rebecca

doi:10.1002/14651858.cd004848

Cited by 81 publications

(41 citation statements)

References 53 publications

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“…Thus, parsing out the independent effect of AEDs on cognitive development is complicated. This is illustrated in a literature review by Adab et al [13] that included 31 studies of cognition and AEDs published between 1974 and 2002. The review highlights these and other confounding factors that were not accounted for in data collection that may have contributed to the differences in study results.…”

Section: In Utero Exposure To Aeds and Cognitionmentioning

confidence: 99%

Antiepileptic Drugs and Neurodevelopment: An Update

Palac

Meador

2011

Curr Neurol Neurosci Rep

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In utero exposure to some antiepileptic drugs (AEDs) is associated with an increased risk of impaired cognitive development. Specifically, valproate and polytherapy exposure are each associated with an increased risk of cognitive impairment in children compared with other antiepileptic medications. The data regarding the risk to neurocognitive development imposed by maternal use of other AEDs are conflicting or insufficient at this time to draw definitive conclusions. Behavioral dysfunction including autistic spectrum disorder is also associated with maternal use of AEDs during pregnancy. Whether treatment with AEDs during childhood permanently affects cognitive neurodevelopment is yet to be determined.

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Section: In Utero Exposure To Aeds and Cognitionmentioning

confidence: 99%

Antiepileptic Drugs and Neurodevelopment: An Update

Palac

Meador

2011

Curr Neurol Neurosci Rep

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“…In 2004, a Cochrane Review concluded that the majority of earlier studies on the effects of in utero exposure to AEDs on postnatal cognitive development are of limited quality, and that there is little evidence about which drugs carry more risks than others to the development of children exposed [2]. A few studies have been published since then which indicate that exposure to valproate might be associated with specific adverse cognitive effects in the child [1,12,14].…”

Section: Some Aeds May Adversely Affect Postnatal Cognitive Developmentmentioning

confidence: 99%

“…A few studies have been published since then which indicate that exposure to valproate might be associated with specific adverse cognitive effects in the child [1,12,14]. A retrospective study from the UK found significantly lower verbal IQ in 41 children exposed to valproate monotherapy than in unexposed children and in children exposed to carbamazepine or phenytoin [2]. Exposure to valproate, five or more tonic-clonic seizures in pregnancy and low maternal IQ were all associated with lower verbal IQ after adjustment for confounding factors.…”

Section: Some Aeds May Adversely Affect Postnatal Cognitive Developmentmentioning

confidence: 99%

Pregnancy and epilepsy: what should we tell our patients?

Tomson

Battino

2009

J Neurol

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Women with epilepsy that plan to become pregnant can in general look forward to uneventful pregnancies and to giving birth to normal children. However, there are certain risks associated with epilepsy and antiepileptic drug (AED) treatment, and it is likely that these risks can be reduced with appropriate prepregnancy counseling. Women with epilepsy should be informed that maintained control of tonic-clonic seizures is important for their health as well as for the well-being of the fetus; that pregnancy in general has little effect on seizure control; but that pregnancy may affect plasma concentrations of AEDs, and that drug level monitoring and dosage adjustments may be needed. They should be informed of the moderately increased risk of birth defects, and that this risk appears to be higher with the use of valproate, in particular at doses above 800 mg/day. The possibility of changing from valproate to another AED should be considered, but such changes should be tried out before conception. Withdrawing or changing an AED should generally be avoided during pregnancy. Women with epilepsy on AED treatment should be encouraged to breast-feed.

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“…In 2004, Adab and colleagues performed a Cochrane review and concluded that in utero exposure to all AEDs was associated with poorer outcomes, as measured with neuropsychological tests. Most effects were subtle in nature and no difference was found between the AEDs [29]. Yet the claim that in utero exposure to VPA in particular induces neurodevelopmental delay persists [26].…”

Section: Introductionmentioning

confidence: 99%