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
...atment...
...eneral
...icians should engage in joint decision-ma...
...treating PWECP, clinicians should recommend ASM...
...ns must minimize the occurrence of c...
...Once a PWECP is already pregnant, clinicians s...
...C. Clinicians should monitor ASM level...
...D. Clinicians should adjust the dose of ASMs at...
...ans treating PWECP using acetazola...
...ngenital Malformations...
...ns must counsel their patients with...
...must consider using lamotrigine, levetirac...
...inicians must avoid the use of valproic acid in P...
...nicians must counsel PWECP who are treated...
...To reduce the risk of cardiac malformations, clin...
...duce the risk of oral clefts, clinicians s...
...o reduce the risk of urogenital and renal m...
...early detection and timely intervention of MC...
3I. To enable early detection and timely inte...
...erinatal Outcome...
...should counsel PWECP that the prevalence of...
...cians should avoid the use of valproic acid o...
...e early identification of fetal growth re...
...odevelopmental Outcome...
.... To reduce the risk of poor neurodev...
...inicians must counsel PWECP who are trea...
...linicians must counsel PWECP who are treated...
...should implement age-appropriate dev...
...ic Acid
...A. Clinicians should prescribe at least 0.4 mg...
...B. Clinicians must prescribe at least 0.4...
...linicians should counsel PWECP treated with...