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Updates on Anti-seizure Medication Use in Pregnancy

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Abstract

Purpose of Review

Care of people with epilepsy and gestational capacity throughout pregnancy involves weighing risks of seizures with the known risks of anti-seizure medications, and requires planning and patient counseling.

Recent Findings

Anti-seizure medications are associated with increased risk of congenital malformations. Further study is needed to understand the risk profile of newer anti-seizure medications in pregnancy. Cognitive outcomes of infants exposed to anti-seizure medications in utero vary, but valproate is associated with an increased risk of cognitive teratogenesis. Topiramate may also have an adverse neurodevelopmental effect though data are conflicting. Anti-seizure medication concentrations fall during pregnancy, so therapeutic drug monitoring and dose adjustment are needed during pregnancy. Peri-conceptual folic acid supplementation has benefits, but the best dose is not known. Anti-seizure medications get into breastmilk, though infant levels are lower than maternal levels and breastfeeding in recommended.

Summary

Recent research highlights that anti-seizure medications have both structural and cognitive teratogenic potential. Further studies into newer anti-seizure medications as well as folic acid dosing are needed to optimize the care of people with epilepsy and gestational capacity throughout pregnancy.

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  1. Northwestern University Feinberg School of Medicine, Chicago, USA

    Alexa King & Elizabeth E. Gerard

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  1. Alexa King
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Correspondence to Alexa King.

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Dr. Gerard reports grant support from being clinical trial PI: Eisai, Sunovion, Xenon, NINDS (U01-NS038455; 2U01-NS038455). She has received support for lectures from Neurology Week and Greenwich Pharmaceuticals. Dr. King reports grant support from Eisei Pharmaceuticals.

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King, A., Gerard, E.E. Updates on Anti-seizure Medication Use in Pregnancy. Curr Obstet Gynecol Rep 12, 37–44 (2023). https://doi.org/10.1007/s13669-023-00359-6

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