Antiseizure Medications Prescribing Practices in Pregnant Women with and Without Epilepsy – a Single Tertiary Epilepsy Center Experience
Abstract number :
2.285
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2024
Submission ID :
190
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Zainab Almusawi, MD – University of Michigan Health System
Subhana asjad, DO – University of Michigan
Temenuzhka Mihaylova, MD, PhD – University of Michigan
Rationale: To study the antiseizure medication (ASM) use in pregnant women with epilepsy (PWWE) and pregnant women without epilepsy at UMHS to inform decisions.
Methods: We searched the electronic medical records through DataDirect. Our search period was from 1/1/21 to12/31/22 with two study cohorts: PWWE on ASM, and pregnant women without epilepsy on ASM.
Results:
61% of PWWE and 84% of pregnant women without epilepsy were treated with monotherapy.
The most used monotherapy in PWWE were levetiracetam (LEV), gabapentin (GBP), and lamotrigine (LTG) and the most common polytherapy were LEV+LTG, Clonazepam+GBP, and GBP+LEV. (Table 1)
The most used monotherapy in pregnant women without epilepsy were GBP, topiramate (TPM), and LTG and the most common polytherapy were Clonazepam+GBP, GBP+pregabalin (PGB), and GBP+TPM. (Table 2)
Conclusions:
Children born to women taking ASMs are at increased risk of major congenital malformations (MCM) and adverse neurodevelopmental outcomes. [1] Multiple factors are associated with this risk including ASM choices. According to the new practice parameters for care of PWWE [2], clinicians should consider using monotherapy with LTG, LEV, or OXC. These ASMs are considered safe during pregnancy based on strong evidence from multiple pregnancy registries. However, pregnancy safety data on many ASMs including GBP, PGB, and Clonazepam are limited (level B) and such prescribing choices should be made carefully and discussed with patients. [2]
Our analysis confirmed that LTG has gained popularity as a safe drug for women of childbearing age. LTG has broader clinical indications than LEV which explains its greater use. Interestingly, OXC was rarely the preferred choice even in the epilepsy cohort whereas ASMs with unknown teratogenic profiles (GBP, PGB, Clonazepam) were used frequently.
The distribution of ASM use found in our study likely reflects current prescribing patterns for pregnant women of childbearing age cared for in tertiary epilepsy centers in the US as reported by the MONEAD study group. [3,4]
More than 65% of pregnancies among WWE are unintended. The ASM regimen is usually the one used at the time of conception. More research is needed on pregnancy outcomes with ASMs to improve knowledge, contribute to expansion of our evidence base, and inform treatment decisions for women of childbearing age.
Funding: None
Clinical Epilepsy