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. 2023 Oct 5:24:100624.
doi: 10.1016/j.ebr.2023.100624. eCollection 2023.

Management of epilepsy in pregnancy: What we still need to learn

Torbjörn Tomson  1 , Leihao Sha  2 , Lei Chen  2
Affiliations

Management of epilepsy in pregnancy: What we still need to learn

Torbjörn Tomson et al. Epilepsy Behav Rep. .

Abstract

Safe pregnancies have been a major concern for women with epilepsy. With more than 50 years of research, we have learned that antiseizure medications (ASMs) differ in their teratogenic risk. Valproate is associated with greater risks for malformations and adverse neurodevelopmental outcomes than other ASMs. Furthermore, seizure control is important for maternal health in pregnancy and it can be affected by a decline in serum concentrations of many ASMs during pregnancy. However, significant knowledge gaps remain. First, there is insufficient evidence about the relative teratogenic risks of most newer generation ASMs, as well as diverse ASM combinations. Similarly, information on gestation-induced changes in maternal serum levels and transfer into breastmilk is inadequate for the majority of the newer ASMs. Further, the optimal dose of folate supplementation remains unknown for women with epilepsy. Finally, most of previous studies on epilepsy and pregnancy come from Europe or North America. Efforts should be made to include more countries in collaboration with existing prospective epilepsy and pregnancy studies to increase the cohort size while at the same time enhancing the generalizability of the results. Large countries, such as China, present great potential to shorten the time to obtain answers to important unsolved questions.

Keywords: Antiseizure medication; Safe pregnancy; Teratogenic risk; Women with epilepsy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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