Abstracts

Rationale: The risk of major congenital malformations, impaired cognitive development, and intrauterine growth restriction, increases following prenatal exposure to antiepileptic drugs (AEDs). The teratogenicity of AEDs largely depends on the type and, for some AEDs, the daily dose of the drug. The aim of this study is to highlight the prevalence of birth defects and the possible fetal adverse events that can result from AEDs use during pregnancy, in a sample of Lebanese women with epilepsy.

Methods: After establishing the first EURAP (International registry of antiepileptic drugs and epilepsy) affiliated center in Lebanon we prospectively monitored pregnancies exposed to 6 types of AEDs (Levetiracetam, Lamotrigine, Carbamazepine, Oxcarbazepine, Valproate, Topiramate). We recruited pregnant women with epilepsy, aged between 18 and 40 years, and taking one or more antiepileptic drugs at conception. Patients’ selection was based on a clinical interview conducted by an epileptologist at Hotel-Dieu de France hospital, a university hopital in Beirut. Patients’ follow-up was done clinically and/or by regular phone calls between November 2020 and May 2022. _x000D_
Results: A total of 23 patients were included in the study, with a mean age of 27 years. Fifteen (65.2%) of the recruited women, had completed secondary education. Thirteen patients (56.5%) were diagnosed with generalized epilepsy, while five patients (21.7%) had focal epilepsy. No major or minor congenital malformations were noted. There were 13 women (56.5%) on monotherapy while 10 (43.5%) were treated by two AEDs. Only three (13%) complications (vaginal bleeding, intrauterine growth restriction), and one miscarriage were observed. Seven (30.4%) patients had seizures during their pregnancies, including three on monotherapy and four on bitherapy. The most used AED during pregnancy was Levetiracetam (69.6%), followed by Lamotrigine (34.8%) but because of limited resources only 5 had serum blood levels checked prior to completing the first trimester. Most patients (87%) were supplemented with folic acid (5 mg/day) at conception, and throughout their pregnancy, while three patients (13%) started folic acid supplementation at pregnancy confirmation._x000D_
Conclusions: Our study is the first to report pregnancy outcome in women with epilepsy in Lebanon and to report the initial data of the Lebanese registry affiliated to the EURAP. Drugs prescribed and dosages used did not induce any birth defects and overall outcome was favorable even though most women struggled to have access to medical care or have drug levels checked because of the economical and healthcare collapse of the country. _x000D_
Funding: None