Abstract
In the United States, there are over one million women with epilepsy (WWE) in their childbearing years. Pregnancy can be challenging for this population. A number of international registries have documented that children born to these women are at increased risk for major congenital malformations (MCM), lower intelligence quotient scores and neurodevelopmental disorders, when the mother is managed on antiseizure medications (ASMs). To prevent poor neonatal outcomes for this population, safe and thoughtful management strategies are necessary. We propose to divide these management strategies into five principles. These include (I) choosing suitable ASMs for the patient's seizure type, (II) choosing an ASM with the least teratogenic and cognitive side effects, (III) dosing at the lowest possible effective dosage, (IV) selecting the best ASM regimen as promptly as possible, even before a woman has her first menses, and (V) supplementing these patients with folic acid in order to try to enhance cognition and reduce neural tube defects.
Highlights
In the United States, there are over one million women with epilepsy (WWE) in their childbearing years [1]
Pregnancy registries have largely contributed to antiseizure medications (ASMs) management in WWE through the evidence of major congenital malformations (MCM) risks
This has been further expanded by the growing evidence of cognitive, behavioral, and emotional effects of in utero ASM exposure provided by studies such as the NEAD study and the Norwegian Mother and Child Cohort Study
Summary
Baylor College of Medicine, United States Merja Hannele Soilu-Hänninen, University of Turku, Finland. In the United States, there are over one million women with epilepsy (WWE) in their childbearing years. To prevent poor neonatal outcomes for this population, safe and thoughtful management strategies are necessary. We propose to divide these management strategies into five principles. These include (I) choosing suitable ASMs for the patient’s seizure type, (II) choosing an ASM with the least teratogenic and cognitive side effects, (III) dosing at the lowest possible effective dosage, (IV) selecting the best ASM regimen as promptly as possible, even before a woman has her first menses, and (V) supplementing these patients with folic acid in order to try to enhance cognition and reduce neural tube defects
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