title: Antiepileptic drugs in women with epilepsy during pregnancy.
abstract: Prescribing antiepileptic drugs (AEDs) in pregnancy is a challenge to the clinician. A multitude of questions arise that must be addressed even prior to conception. In women with proven epilepsy, it may be dangerous to stop or even change the AED regimen during pregnancy. Changes could lead to injury or death in both the mother and the fetus. In the rare cases when discontinuing an AED is plausible, it should be done methodically in consultation with the physician prior to conception. Most women with epilepsy are consigned to continue their AEDs before, during and after pregnancy. The metabolism of AEDs may change drastically during pregnancy. These changes must be addressed by the clinician. Drug levels should be monitored consistently during pregnancy. The risks to the fetus must be delineated in terms of side effects from specific drugs as well as risks from the seizure disorder itself. Many AEDs have well known teratogenic effects, and these must be elucidated to the mother. There are risks (theoretical and evidence based) for obstetrical complications, poor neonatal outcomes, congenital malformations and even cognitive effects on the child later in life. These risks are addressed in this article with respect to individual AEDs. Recommendations include but are not limited to preconception counseling, taking folate pre and post conception, prescribing the most effective AED while minimizing risks, and avoiding polytherapy and valproate if possible.
authors.forename: Evan
authors.initials: E
authors.lastname: Gedzelman
authors.forename: Kimford J
authors.initials: KJ
authors.lastname: Meador
keywords: antiepileptic drugs; congenital malformations; epilepsy; neurodevelopment; pregnancy
references.citation: Epilepsy Behav. 2009 Nov;16(3):426-30
references.pmid: 19854113
references.citation: Epilepsy Res. 2009 Apr;84(2-3):245-9
references.pmid: 19231139
references.citation: Seizure. 2010 Mar;19(2):112-9
references.pmid: 20036166
references.citation: Lancet. 1968 Dec 14;2(7581):1296
references.pmid: 4177489
references.citation: J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1575-83
references.pmid: 15491979
references.citation: Pharmacoepidemiol Drug Saf. 2007 Nov;16(11):1203-10
references.pmid: 17894421
references.citation: Neurology. 2000;55(5 Suppl 1):S21-31; discussion S54-8
references.pmid: 11001359
references.citation: Neurology. 2008 Dec 2;71(23):1923-4
references.pmid: 19047565
references.citation: BMJ. 2010 Dec 02;341:c6581
references.pmid: 21127116
references.citation: Epilepsy Behav. 2006 Sep;9(2):293-7
references.pmid: 16861045
references.citation: Arch Womens Ment Health. 2007;10(5):181-7
references.pmid: 17726640
references.citation: Lancet. 1976 Feb 7;1(7954):272-5
references.pmid: 55587
references.citation: Dev Med Child Neurol. 1990 May;32(5):432-41
references.pmid: 1972364
references.citation: JAMA. 2011 May 18;305(19):1996-2002
references.pmid: 21586715
references.citation: J Matern Fetal Neonatal Med. 2007 Mar;20(3):189-209
references.pmid: 17437220
references.citation: Teratology. 2000 Mar;61(3):196-202
references.pmid: 10661909
references.citation: J Neurol Neurosurg Psychiatry. 2001 Jan;70(1):15-21
references.pmid: 11118242
references.citation: JAMA. 1995 Nov 15;274(19):1518-25
references.pmid: 7474220
references.citation: BJOG. 2008 Jul;115(8):1043-51
references.pmid: 18651886
references.citation: Epilepsia. 2004 Nov;45(11):1465
references.pmid: 15509251
references.citation: Epilepsy Res. 2005 Jul;65(3):189-200
references.pmid: 16029946
references.citation: Neurology. 2004 Sep 28;63(6):1008-14
references.pmid: 15452291
references.citation: Exp Neurol. 2004 Jun;187(2):403-9
references.pmid: 15144866
references.citation: Epilepsy Behav. 2007 Nov;11(3):292-302
references.pmid: 17996637
references.citation: Curr Neurol Neurosci Rep. 2011 Aug;11(4):423-7
references.pmid: 21465150
references.citation: Ann N Y Acad Sci. 2003 May;993:103-14; discussion 123-4
references.pmid: 12853301
references.citation: Neurology. 2009 Dec 1;73(22):1831-6
references.pmid: 19923552
references.citation: J Pediatr. 1976 Oct;89(4):662-8
references.pmid: 957016
references.citation: J Womens Health (Larchmt). 2007 Jun;16(5):678-91
references.pmid: 17627403
references.citation: Pharmacoepidemiol Drug Saf. 2010 Aug;19(8):803-7
references.pmid: 20680999
references.citation: Epilepsia. 1999 Sep;40(9):1237-43
references.pmid: 10487186
references.citation: JAMA. 1994 Mar 9;271(10):767-70
references.pmid: 7509419
references.citation: Epilepsia. 2006 Jan;47(1):186-92
references.pmid: 16417548
references.citation: Neurotoxicol Teratol. 1992 Sep-Oct;14(5):329-35
references.pmid: 1454041
references.citation: Arch Neurol. 2011 Oct;68(10):1275-81
references.pmid: 21670385
references.citation: Neurology. 2005 Mar 22;64(6):961-5
references.pmid: 15781808
references.citation: Exp Neurol. 2005 Jun;193(2):497-503
references.pmid: 15869952
references.citation: Neurology. 2009 Jul 14;73(2):133-41
references.pmid: 19398681
references.citation: Neurology. 2006 Nov 28;67(10):1876-9
references.pmid: 17130430
references.citation: Epilepsia. 2010 May;51(5):805-10
references.pmid: 19817810
references.citation: Neurology. 2006 Feb 14;66(3):354-60
references.pmid: 16382034
references.citation: BMJ. 1998 Sep 26;317(7162):839-43
references.pmid: 9748174
references.citation: Neurology. 2011 Jan 25;76(4):383-9
references.pmid: 21263139
references.citation: J Neuropathol Exp Neurol. 2002 Nov;61(11):956-67
references.pmid: 12430712
references.citation: Acta Paediatr. 2002;91(4):409-14
references.pmid: 12061356
references.citation: J Pediatr. 1989 Jan;114(1):126-31
references.pmid: 2562851
references.citation: Best Pract Res Clin Endocrinol Metab. 2008 Jun;22(3):477-88
references.pmid: 18538287
references.citation: Neurology. 2008 Jul 22;71(4):272-6
references.pmid: 18645165
references.citation: Neurology. 2007 Jan 30;68(5):326-37
references.pmid: 17261678
references.citation: Eur J Obstet Gynecol Reprod Biol. 2002 Mar 10;101(2):147-54
references.pmid: 11858890
references.citation: Neurology. 2004 Jan 27;62(2):292-5
references.pmid: 14745072
references.citation: Pediatrics. 2005 Sep;116(3):703-8
references.pmid: 16140711
references.citation: Dev Med Child Neurol. 2005 Aug;47(8):551-5
references.pmid: 16108456
references.citation: J Pharmacol Exp Ther. 2007 Oct;323(1):165-73
references.pmid: 17636003
references.citation: BJOG. 2000 Jul;107(7):896-902
references.pmid: 10901562
references.citation: J Nutr. 2004 Jan;134(1):162-6
references.pmid: 14704311
references.citation: Ann Neurol. 2005 Aug;58(2):266-76
references.pmid: 16049923
references.citation: Eur J Neurol. 2006 Jun;13(6):645-54
references.pmid: 16796590
references.citation: Epilepsia. 2009 Sep;50(9):2163-6
references.pmid: 19490048
references.citation: Curr Neuropharmacol. 2009 Jun;7(2):115-9
references.pmid: 19949569
references.citation: J Clin Neurosci. 2007 Jul;14(7):611-7
references.pmid: 17400456
references.citation: Int Rev Neurobiol. 2008;83:227-40
references.pmid: 18929085
references.citation: JAMA. 1994 Sep 21;272(11):850-1
references.pmid: 7521402
references.citation: Arch Neurol. 2004 May;61(5):673-8
references.pmid: 15148143
references.citation: Neurology. 2002 Jul 23;59(2):251-5
references.pmid: 12136066
references.citation: J Clin Neurosci. 2006 Jan;13(1):103-4
references.pmid: 16410205
references.citation: Epilepsy Res. 2008 Sep;81(1):1-13
references.pmid: 18565732
references.citation: J Pharmacol Exp Ther. 2007 Aug;322(2):494-500
references.pmid: 17483293
references.citation: Ann Neurol. 2008 Oct;64(4):434-45
references.pmid: 18991352
references.citation: Neurology. 2008 May 27;70(22 Pt 2):2130-6
references.pmid: 18046009
references.citation: J Pediatr. 1988 Oct;113(4):677-84
references.pmid: 2459362
references.citation: N Engl J Med. 1990 Feb 8;322(6):364-9
references.pmid: 2242106
references.citation: Epilepsy Res. 2010 Jan;88(1):11-22
references.pmid: 19825509
references.citation: Neurology. 2009 Jul 14;73(2):142-9
references.pmid: 19398680
references.citation: J Int Neuropsychol Soc. 2011 Jan;17(1):133-42
references.pmid: 21092354
references.citation: Epilepsy Res. 2005 Jul;65(3):185-8
references.pmid: 16084694
references.citation: Nat Neurosci. 2001 Apr;4(4):351-2
references.pmid: 11276221
references.citation: Lancet Neurol. 2011 Jul;10(7):609-17
references.pmid: 21652013
references.citation: Arch Neurol. 2009 Aug;66(8):979-84
references.pmid: 19667219
references.citation: Neurosci Biobehav Rev. 2005 Apr;29(2):259-69
references.pmid: 15811497
references.citation: Neurology. 2004 Jan 13;62(1):28-32
references.pmid: 14718692
references.citation: J Neurol Neurosurg Psychiatry. 2009 May;80(5):506-11
references.pmid: 18977812
references.citation: Epilepsia. 2009 Sep;50(9):2130-9
references.pmid: 19490036
references.citation: J Child Psychol Psychiatry. 2003 Oct;44(7):1025-36
references.pmid: 14531585
references.citation: Brain. 2011 Feb;134(Pt 2):396-404
references.pmid: 21224309
references.citation: N Engl J Med. 2010 Jun 10;362(23):2185-93
references.pmid: 20558369
references.citation: Science. 2000 Feb 11;287(5455):1056-60
references.pmid: 10669420
references.citation: Aust N Z J Obstet Gynaecol. 2007 Dec;47(6):468-74
references.pmid: 17991111
references.citation: Proc Natl Acad Sci U S A. 2002 Nov 12;99(23):15089-94
references.pmid: 12417760
references.citation: Neurology. 2003 Feb 25;60(4):575-9
references.pmid: 12601095
references.citation: Epilepsy Behav. 2009 Jan;14(1):197-201
references.pmid: 18992367
references.citation: J Neurosci. 2003 Nov 5;23(31):10002-12
references.pmid: 14602814
references.citation: Seizure. 1999 Sep;8(6):322-7
references.pmid: 10512771
references.citation: J Neurol Neurosurg Psychiatry. 2006 Feb;77(2):193-8
references.pmid: 16157661
references.citation: Neurology. 2009 Jul 14;73(2):126-32
references.pmid: 19398682
references.citation: Epilepsy Behav. 2009 Jun;15(2):230-4
references.pmid: 19328868
references.citation: BJOG. 2011 Jul;118(8):956-65
references.pmid: 21557799
references.citation: J Child Psychol Psychiatry. 2008 Oct;49(10):1079-88
references.pmid: 19017024
references.citation: Neurology. 2008 Sep 30;71(14):1109-17
references.pmid: 18703463
references.citation: Acta Paediatr. 1994 Sep;83(9):961-6
references.pmid: 7529601
references.citation: Epilepsia. 2009 Jan;50 Suppl 1:24-7
references.pmid: 19125843
references.citation: Neurology. 2008 Sep 2;71(10):714-22
references.pmid: 18650491
references.citation: Epilepsia. 2007 Apr;48(4):684-93
references.pmid: 17437411
references.citation: Neurology. 2005 Jun 14;64(11):1874-8
references.pmid: 15955936