Pharmacology of antiepileptic drugs during pregnancy and lactation.
Most women with epilepsy require continuous treatment during pregnancy, making antiepileptic drugs (AEDs) one of the most frequent chronic teratogen exposures. Therapeutic decisions should balance the risks to the developing fetus of AED exposure and of not treating or undertreating the epilepsy. The International AED Pharmacology Work Group of the Health Outcomes in Pregnancy and Epilepsy (HOPE) Forum identified four pharmacology topics critical to enhancing maternal and fetal outcomes for pregnancies exposed to AEDs: (1) hormonal therapies and endogenous changes: bidirectional interactions with AEDs; (2) pharmacokinetic alterations during pregnancy, the role of therapeutic drug monitoring, and the influence on seizure control and maternal and fetal outcomes; (3) multidrug transporters and their various roles during pregnancy; (4) breastfeeding in mothers taking AEDs. The report provides an overview of these key topics, highlights gaps in the current knowledge, and provides future directions for needed research.
Pennell
Page B
PB
Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA. page.pennell@emoryhealthcare.org
Gidal
Barry E
BE
Sabers
Anne
A
Gordon
Jacki
J
Perucca
Emilio
E
D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D004827:Epilepsy / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007774:Lactation / Q000187:drug effects*; D011247:Pregnancy / Q000187:drug effects*; D011248:Pregnancy Complications / Q000139:chemically induced*
D000927:Anticonvulsants