Changes over 24 years in a pregnancy register - Teratogenicity and epileptic seizure control

Frank Vajda; Terence O'Brien; Janet Graham; Alison Hitchcock; Piero Perucca; Cecilie Lander; Mervyn Eadie

doi:10.1016/j.yebeh.2023.109482

Changes over 24 years in a pregnancy register - Teratogenicity and epileptic seizure control

Epilepsy Behav. 2023 Nov:148:109482. doi: 10.1016/j.yebeh.2023.109482. Epub 2023 Oct 13.

Authors

Frank Vajda¹, Terence O'Brien², Janet Graham³, Alison Hitchcock⁴, Piero Perucca⁵, Cecilie Lander⁶, Mervyn Eadie⁷

Affiliations

¹ Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia; Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia. Electronic address: vajda@netspace.net.au.
² Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia. Electronic address: te.obrien@alfred.org.au.
³ Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia. Electronic address: janet.graham@mh.org.au.
⁴ Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia. Electronic address: alison.hitchcock2@mh.org.au.
⁵ Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia; Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia; Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, VIC 3084, Australia; Bladin-Berkovic Comprehensive Epilepsy Program, Austin Health, Heidelberg, VIC 3084, Australia. Electronic address: piero.perucca@unimelb.edu.au.
⁶ Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, QLD 4027, Australia. Electronic address: cecilielander@bigpond.com.
⁷ Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, QLD 4027, Australia. Electronic address: m.eadie@uq.edu.au.

PMID: 37839246
DOI: 10.1016/j.yebeh.2023.109482

Abstract

Objectives: To trace (i) changes in Australian Pregnancy Register (APR) records concerning antiseizure medications (ASMs) prescribed for women with epilepsy (WWE) over the course of 24 years and correlate the changes with (ii) rates of occurrence of pregnancies involving foetal malformations, (iii) the body organs involved in the malformations, and (iv) freedom from epileptic seizures.

Results: Use of valproate and carbamazepine decreased progressively, use of lamotrigine remained relatively static, and the use of levetiracetam increased progressively, whereas the use of topiramate first increased and then fell again, associated with a temporary increase in malformation-associated pregnancy rate. More serious malformations, such as spina bifida, became less frequent, whereas more trivial ones tended to increase, whereas epileptic seizure freedom rates improved.

Conclusions: The increasing use of newer ASMs in pregnant women has been associated with overall advantages in relation to the frequency and severity of foetal malformation and with advantages in relation to freedom from epileptic seizures.

Keywords: Antiseizure medication (ASM); Carbamazepine; Foetal malformation; Pregnancy; Seizure control; Topiramate; Valproate.

MeSH terms

Anticonvulsants / adverse effects
Australia / epidemiology
Epilepsy* / drug therapy
Epilepsy* / epidemiology
Female
Humans
Lamotrigine / therapeutic use
Pregnancy
Pregnancy Complications* / drug therapy
Pregnancy Complications* / epidemiology
Seizures / drug therapy
Seizures / epidemiology
Valproic Acid / therapeutic use

Substances

Anticonvulsants
Lamotrigine
Valproic Acid