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
...inicians should engage in joint decision-ma...
...When treating PWECP, clinicians should...
...cians must minimize the occurrence of convulsive...
...Once a PWECP is already pregnant, clinicians sh...
...ans should monitor ASM levels in PWECP throug...
.... Clinicians should adjust the dose of ASMs at the...
...cians treating PWECP using acetazola...
...genital Malformations...
...A. Clinicians must counsel their patie...
.... Clinicians must consider using lamotrigine,...
...ians must avoid the use of valproi...
...nicians must counsel PWECP who are treated...
...educe the risk of cardiac malformati...
...e the risk of oral clefts, clinicians s...
...e the risk of urogenital and renal malformati...
...enable early detection and timely interventi...
.... To enable early detection and timely int...
Perinatal Outco...
...s should counsel PWECP that the prevalence...
...icians should avoid the use of valproic acid or...
...o enable early identification of fetal grow...
...evelopmental Outcome...
...uce the risk of poor neurodevelopm...
.... Clinicians must counsel PWECP who are trea...
...Clinicians must counsel PWECP who are trea...
...cians should implement age-appropriate deve...
...lic Acid
...inicians should prescribe at least 0.4 mg...
6B. Clinicians must prescribe at least 0.4 mg o...
.... Clinicians should counsel PWECP treated with an...