Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After in Utero Exposure to Antiseizure Medication

Publication Date: May 15, 2024

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

...reatment

...enera...

...should engage in joint decision-making with P...

...n treating PWECP, clinicians should recommend AS...

...s must minimize the occurrence of convulsive seizu...

...a PWECP is already pregnant, clinicians...

...cians should monitor ASM levels in PWECP...

...linicians should adjust the dose of...

...linicians treating PWECP using acetazolamide, e...


Major Congenital Malfor...

...icians must counsel their patients w...

...s must consider using lamotrigine, levetiracetam,...

...s must avoid the use of valproic acid in PWECP...

...must counsel PWECP who are treated with, or are co...

...o reduce the risk of cardiac malformations, cl...

.... To reduce the risk of oral clefts,...

...To reduce the risk of urogenital and renal malf...

...To enable early detection and timely inte...

...e early detection and timely intervention o...


...erinatal Outco...

...A. Clinicians should counsel PWECP that the preva...

.... Clinicians should avoid the use of valpro...

...o enable early identification of fet...


...evelopmental Outcom...

...e risk of poor neurodevelopmental outcomes, i...

...ns must counsel PWECP who are treated with,...

...ans must counsel PWECP who are treated wi...

...ans should implement age-appropriat...


...olic Ac...

...ans should prescribe at least 0.4 mg of folic acid...

...must prescribe at least 0.4 mg of folic a...

...hould counsel PWECP treated with an ASM that a...