Pregnancy and AEDs

Uncontrolled seizures are more dangerous for the mother and the fetus than AEDs.

Over 90% of women with epilepsy that are treated with AEDs give birth to healthy babies.

The risk of teratogenicity and neurocognitive disturbances after birth is dose dependent.

Of all AEDs Valproate carries the highest risk for teratogenicity and neurocognitive disturbances, especially in higher doses.

Preliminary data suggest low risk with Levetiracetam compared to Carbamazepine and Lamotrigine.

Preliminary data suggest high risk with Topiramate.

Strive for monotherapy under pregnancy when possible.

Avoid valproate in doses >500mg/day.

Optimise treatment before conception. Consider switching from polytherapy to monotherapy. Consider withdrawal if the patient is on remission. Establish the minimum effective dose and document serum concentration.

Pharmacokinetics of many AEDs is altered during pregnancy because of increased volume of distribution, lower serum albumin, faster metabolism.

Most notable AEDs that need significant dose adjustment after conception are Lamotrigine and Phenytoin.

Adjust the dose of AEDs immediately after conception. Monitor serum concentration under pregnancy. Return to pre-pregnancy dosing within 2 weeks after delivery.