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
...reatment
Gener...
...ans should engage in joint decision-...
...g PWECP, clinicians should recommend...
...must minimize the occurrence of con...
...Once a PWECP is already pregnant, clini...
...icians should monitor ASM levels in...
...Clinicians should adjust the dose of ASMs...
...treating PWECP using acetazolamide,...
...jor Congenital Malformat...
...must counsel their patients with epilepsy that th...
...ust consider using lamotrigine, levetiracetam, or...
...must avoid the use of valproic acid...
...cians must counsel PWECP who are treated with,...
...To reduce the risk of cardiac malformation...
...duce the risk of oral clefts, clinic...
...e the risk of urogenital and renal...
3H. To enable early detection and tim...
...nable early detection and timely inter...
...erinatal Out...
...inicians should counsel PWECP that...
...inicians should avoid the use of va...
...ble early identification of fetal growth rest...
...rodevelopmental Outc...
...uce the risk of poor neurodevelopmental out...
...icians must counsel PWECP who are...
...must counsel PWECP who are treated...
.... Clinicians should implement age-a...
Folic Ac...
...icians should prescribe at least 0.4 mg of f...
.... Clinicians must prescribe at least 0.4 mg of...
...nicians should counsel PWECP treate...