Impact of Changes in AED Selection on the Risk of Adverse Pregnancy Outcomes

سال انتشار: 1398
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 328

نسخه کامل این مقاله ارائه نشده است و در دسترس نمی باشد

استخراج به نرم افزارهای پژوهشی:

لینک ثابت به این مقاله:

شناسه ملی سند علمی:

EPILEPSEMED16_084

تاریخ نمایه سازی: 28 بهمن 1398

چکیده مقاله:

Prospective studies have provided in recent years new information on the comparative teratogenic risks of antiepileptic drugs (AEDs), enabling a more rational approach to the management of epilepsy in women of childbearing potential. Largely, this information comes from registries initiated some 20 years ago, each enrolling thousands of pregnancies and assessing rates of major congenital malformations (MCMs) following exposure to different AEDs. Smaller scale prospective cohort studies provided comparative data on neurodevelopment of children born from mothers taking AEDs during their pregnancy. Valproate is the drug with the highest risk, whereas prevalence of MCMs is lowest with lamotrigine, levetiracetam and oxcarbazepine. For valproate, phenobarbital, phenytoin, carbamazepine, and lamotrigine, the risk of MCMs is dose-dependent. Prenatal exposure to valproate has also been confirmed to cause an increased risk of cognitive impairments and autistic traits. Based on these emerging data and due to regulatory restrictions on the use of valproate in female patients, there has been a marked shift in AED selection for the treatment during pregnancy over the last years. While the use of valproate, and of carbamazepine has declined substantially, lamotrigine and levetiracetam are prescribed much more often during pregnancy. Prospective pregnancy registries have attempted to analyse changes in pregnancy outcomes in relation to this shift in treatment strategies. EURAP, the international antiepileptic drugs and pregnancy registry, noted a 27% decline in the prevalence of MCMs over a 14 years period, an improvement that is most likely explained by changes in AED selection.

نویسندگان

Torbjörn Tomson

Senior professor of Neurology at the Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden