Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After in Utero Exposure to Antiseizure Medication
Key Points
Key Points
- Prioritize shared decision-making with people with epilepsy of childbearing potential (PWECP) to find the proper combination of medications that optimize both seizure control and fetal outcomes before pregnancy.
- Stopping antiseizure medications (ASMs) during pregnancy can increase seizure frequency, which can harm both the patient and the child.
- Avoid valproic acid, phenobarbital, and topiramate (in that order) if clinically feasible to minimize risk of major congenital malformations (MCMs) and unfavorable perinatal and neurodevelopmental outcomes.
- Recommend folic acid supplementation for PWECP to decrease the risk of neural tube defects, possibly decrease the risk of autism spectrum disorder, and help improve IQ in their offspring.
Treatment
Treatm...
Gener...
...Clinicians should engage in joint decision-mak...
...ting PWECP, clinicians should recommend ASMs and d...
...ans must minimize the occurrence of...
.... Once a PWECP is already pregnant, clinicians sh...
2C. Clinicians should monitor ASM levels in PWE...
...linicians should adjust the dose of ASMs at thei...
...reating PWECP using acetazolamide, e...
...ongenital Malformations
...Clinicians must counsel their patients wit...
...ns must consider using lamotrigine, levetir...
...linicians must avoid the use of valproic...
...cians must counsel PWECP who are tr...
...E. To reduce the risk of cardiac malformation...
...To reduce the risk of oral clefts, c...
...e the risk of urogenital and renal malformati...
3H. To enable early detection and timely interv...
...enable early detection and timely interven...
...erinatal Outcome...
...A. Clinicians should counsel PWECP that th...
...should avoid the use of valproic a...
...rly identification of fetal growth...
...elopmental Outcomes...
...e risk of poor neurodevelopmental outcomes, includ...
...s must counsel PWECP who are treated with, or...
...cians must counsel PWECP who are treat...
...icians should implement age-appropriate dev...
...olic Acid...
...s should prescribe at least 0.4 mg of folic...
...B. Clinicians must prescribe at least 0.4...
...nicians should counsel PWECP treated w...