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
Treatmen...
Genera...
...cians should engage in joint decision-making wit...
...When treating PWECP, clinicians shoul...
...linicians must minimize the occurr...
...a PWECP is already pregnant, clinicians should...
...cians should monitor ASM levels in PWECP throu...
...icians should adjust the dose of ASMs at their c...
...ns treating PWECP using acetazolami...
...Congenital Malformations
...Clinicians must counsel their patients with epile...
3B. Clinicians must consider using l...
...nicians must avoid the use of valpr...
...Clinicians must counsel PWECP who are...
...o reduce the risk of cardiac malfo...
...reduce the risk of oral clefts, clinician...
...o reduce the risk of urogenital and renal mal...
...e early detection and timely interve...
...enable early detection and timely interventi...
...inatal Outcomes...
...should counsel PWECP that the prevale...
...should avoid the use of valproic acid or t...
...enable early identification of fetal gro...
...lopmental Outcomes...
...the risk of poor neurodevelopmental outcomes, in...
...Clinicians must counsel PWECP who a...
...C. Clinicians must counsel PWECP who are tre...
...inicians should implement age-appropriate developm...
Folic Aci...
...icians should prescribe at least 0.4 mg of fol...
...icians must prescribe at least 0.4 mg of folic aci...
...nicians should counsel PWECP treated...