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
Treatme...
...enera...
...linicians should engage in joint d...
...When treating PWECP, clinicians should...
...Clinicians must minimize the occurrence of...
...is already pregnant, clinicians should exercis...
...inicians should monitor ASM levels i...
...ns should adjust the dose of ASMs at their clinica...
...Clinicians treating PWECP using acetazolami...
...Congenital Malformati...
...must counsel their patients with epileps...
...Clinicians must consider using lamotrigine, levet...
...ians must avoid the use of valproic acid in PWECP...
.... Clinicians must counsel PWECP who are treat...
...e risk of cardiac malformations, clinic...
...uce the risk of oral clefts, clinic...
...reduce the risk of urogenital and renal...
...arly detection and timely intervention...
...ble early detection and timely intervention of...
...natal Outcomes
...ans should counsel PWECP that the preva...
...Clinicians should avoid the use of valproic acid...
...able early identification of fetal growth rest...
Neurodevelopmental Out...
...the risk of poor neurodevelopmental outcomes, inc...
...s must counsel PWECP who are treated wi...
...icians must counsel PWECP who are treated...
...icians should implement age-appropriate devel...
Folic Ac...
...hould prescribe at least 0.4 mg of...
...s must prescribe at least 0.4 mg of fol...
...inicians should counsel PWECP treated with a...