Excellent article that covers the use of anticonvulsants during pregnancy. As expected Valproic acid is the worst and should be avoided. Folic Acid is greatly beneficial to the fetus. Not much data on the newer anticonvulsants but many are safer. Good read. TWH
Expert Opin Pharmacother. 2018 Dec 10:1-10. doi: 10.1080/14656566.2018.1550073. [Epub ahead of print]
Therapeutic strategies for treating epilepsy during pregnancy.
Counseling for women with epilepsy of childbearing potential surrounding pregnancy issues is of the utmost importance and should be done when antiepileptic medications are prescribed and reviewed regularly at clinic visits. Physicians must be familiar with risks associated with antiepileptic medication, and endeavor to minimize risks to a fetus while selecting best medications for epilepsy type. Areas covered: The authors discuss the role of folic acid, updated evidence relating to the occurrence of major congenital malformations and neurocognitive risks associated with antiepileptic medication. They also examine the rationale for monitoring drug levels, optimum delivery strategies, and evidence for the safety of breastfeeding while taking antiepileptic medication. Expert opinion: Valproate carries the highest known teratogenic risk in pregnancy and should only be prescribed to women of child-bearing potential in a specialist setting. There is a need for the ongoing register collection of risks associated with newer AEDs which lack substantial (major) data. Choosing these newer medications can create a dilemma for physicians, particularly when seizures are not well controlled or where treatment options are limited. The authors advocate a multidisciplinary team approach to managing women with epilepsy so that pregnancies in such women can be well managed in an optimum and individualized fashion.
Antiepileptic medication; epilepsy; major congenital malformation; pregnancy; therapeutic drug monitoring