Abstracts

Rationale: Use of certain antiseizure medications (ASMs) during pregnancy increases the risk of major congenital malformations, while less is known about newer ASMs, such as lacosamide (LCM). Published peer review data is limited to a prospective case series of three cases of maternal exposure to LCM with a good level of efficacy and safety.

Methods: We retrospectively identified 14 pregnancies in 10 women with epilepsy (WWE) exposed to LCM during pregnancy and described the maternal and neonatal outcomes. We reviewed the patients' medical records as well as those of their infants to identify complications during pregnancy and delivery, neonatal complications, and evidence of major/minor congenital malformations. Study received approval from the institution’s Quality Improvement Project Review Committee.

Results: Our series included 14 pregnancies (10 patients; age range at time of pregnancy 20-37 years old) with maternal exposure to LCM at conception. Eight women had focal epilepsy while two had generalized epilepsy. LCM dosages ranged from 100 to 400 mg and exposure was limited to the first trimester for two pregnancies and during the full course for 12 pregnancies. All women were on polytherapy during pregnancy (ASMs number ranging from 2-4) with other agents used being lamotrigine and levetiracetam followed by zonisamide, topiramate, perampanel and cannabidiol oil. Breakthrough seizures occurred in four out of nine patients with frequency similar to baseline prior to conception. There were nine live births and five spontaneous miscarriages with gestational age under eight weeks. Four out of five patients with miscarriages had additional full-term pregnancies, out of which three were with LCM exposure. One woman had preeclampsia, but none had neurological complications during pregnancy. Seven pregnancies were full term and two preterm deliveries. Two full term and one preterm delivery were via cesarean section. Nine healthy infants were born with Apgar scores ranging from 7-9 and no major congenital malformations. There was one minor congenital malformation, characterized by polydactyly, observed in an infant to a mother with concomitant exposure to topiramate throughout pregnancy.

Conclusions: Worldwide pregnancy registries have provided consistent and increasing information about the effect of exposure to older ASMs during gestation on pregnancy and neonatal outcomes, while data is lacking for LCM. Women in our cohort were all on polytherapy which might have contributed to the increased rate of miscarriage as previously reported in published literature. Conclusions regarding a causal relationship between LCM and miscarriage could thus be misleading based on our data alone. Our cohort, albeit small, did not reveal any major congenital malformations. Larger prospective cohorts are needed to determine the safety of LCM in pregnancy.

Funding: Please list any funding that was received in support of this abstract.: None.