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Antiepileptic Drug Safety In Pregnancy


A pregnant women with epilepsy frequently experience seizures related to pregnancy complications so they often prescribed antiepileptic drugs to manage their symptoms . Epilespy in pregnant women increase the risk of pregnancy-related complication .Epilepsy is the most common chronic neurological condition which effects the (0.6–1%) of population , antiepileptic drugs (AEDs) are prescribed to reduce the seriousness of epilepsy or help to control the other conditions such as : pain, psychiatric disorders, and migraine , Women taking antiepileptic drugs have a greater risk of miscarriage and teratogenicity, including (4–8%) chance of giving birth to a child with a major congenital malformation , because these agents can be transferred to the fetus via the placenta. The use of many first-generation Antiepileptics ( like: valproate) in pregnant women with epilepsy has been seen a several large-scale pregnancy registries were established to evaluate the safety of first- and newer-generation (like :gabapentin) antiepileptic . As such, we compared the safety of AEDs in infants and children exposed in utero through a systematic review and network meta-analysis (NMA).

In women with proven epilepsy, it may be dangerous to stop or even change the AED regimen during pregnancy. Changes could lead to injury or death in both the mother and the fetus. In the rare cases when discontinuing an AED is plausible, it should be done methodically in consultation with the physician prior to conception,most women with epilepsy are consigned to continue their AEDs before, during and after pregnancy. The metabolism of AEDs may change drastically during pregnancy.When considering foetal malformations, the most desirable antiepileptic agents appear to be levetiracetam and probably lamotrigine. Of course, other matters such as seizure control in pregnancy have to be considered, particularly if antiepileptic drug regimens have to be changed before, or during, early pregnancy.

There are two classes of epileptic syndrome:

• Partial Seizure:-
- It involves 15% of partial seizure.

1) Complex partial Seizures : ( Psycomotor seizures)
- It involve clouding of consciousness.

2) Simple Motor seizures :
- Recovery is very rapid.
- consciousness is not lost .
- It can effect the sensory function.

• Generalize Seizures :-

- It involves 85% of seizures.
- It involve both hemispheres spontaneously.
- Occur by a strong herediatry component.

1) Grand Mal Seizures:
- Loss of consciousness.
- Clinic contraction .
- Tonic contraction of muscles.

2) Petit Mal Seizures:
- Absence of Seizures.
- Brief loss of consciousness with no muscle activity.
- Immediate recovery of consciousness.

Causes Of Seizures :

- Trauma.
- Brain tumors.
- Biochemical abnormalities.
- Arteriovenous malformation.

What Are The Major Pregnancy Related Threats To Women With Epilespy ?

Increased seziures rate:

- Caused by nausea & vomiting.
- Pregnancy hypervolemia offset by protein binding.
- Discontinue medication.

- Hyperventilation & pain during labour

Risks for fetal malformation:

- Untreated epilepsy is not associate with increase malformation.
- Teratogenic effect of AECDs are following :
• Pregnancy loss.
• Congenital malformation.
• Fetal anticonvulsant syndrome.

  1. Lamictal is the best first-choice drug for partial epilepsy, while valproic acid is the best first choice for generalized epilepsy.
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Anti-epileptic Drugs Which Are Safe During Pregnancy Are Following:-

1) Levetiracetam :

It is the drug which is obliged to be effective in controlling seizures during pregnancy and relatively free of teratogenic side effects. But data on its efficacy and teratogenicity during pregnancy are limited. It is an anticonvulsant which decreased the number of seizures.

Drug Interaction:

- Deutetrabenazine.
- Lurasidone.
- Orlistat.
- Sevelamer.

2) Phenytoin:

It works by slowing down impulses in the brain that causeseizures. It. Is used to control seizures, it doesn't treat all types of seizures.

- It has a high burning date to protein 90-93%.
- Route of elimination is hepatic metabolism.
- Substantial increase occur during pregnancy.
- 90% intravenous bioavailability.

• Drug Interaction:

- Ethosuximide.
- Felbamate.
- Oxcarbazepine.
- Methsuximide.
- Topiramate.

3) Carbamazepine:

It works by decreasing nerve impulses that cause seizures & nerve pain, such as trigeminal neuralgia and diabetic neuropathy. Carbamazepine is also used to treat bipolar disorder. It may also be used for purposes not listed in this medication guide.

- It has relatively slow absorption.
- protein binding to albumin 70 80%.
- Drug level and bioavailability lower in pregnancy.
- Route of elimination are hepatic metabolism.

Drug Interaction :

- Isavuconazonium.
- Voriconazole.
- Orlistat.
- MAO inhibitors.

4) phenobarbital :

It is a class of medications called barbiturates. It is used to treat insomnia (difficulty in sleeping)and as a sedative to relieve the symptoms of anxiety or tension. It is also used for the control of certain types of seizures. It works by slowing down the brain and nervous system.

- It has high oral bioavailability 90%.
- It has protein bound 50%.
- Route of elimination is a hepatic metabolism.
- Impaired cognitive function.
- It has long elimination half life.

Drug Interaction :

- Blood thinners such as warfarin.
- Codeine.
- Ibuprofen.
- Clonazepam.
- Levetiracetam.

5) ValporicAcid :

It is used to treat various types of seizure disorders. Valproic acid is sometimes used together with other seizure medications. It is also used to treat manic episodes related to bipolar disorder & to prevent migraine headaches.

- This drug is rapidly absorbed.
- It is highly protein bound to plasma albumin 88-92%.
- It has a wide therapeutic index.

Drug Interaction :

- Warfarin.
- Antidepressants.
- Antibiotics.
- Refampin.

Overseeing in pregnancy:

- Major goal is seizure prevention.
- Medication complication.
- Prevention seizure provoking stimuli.
- Anticonvulsant should be maintained at low dose which associated with seizure control.
- Routinely monitored the serum drug level during pregnancy.
- Monotherapy:
° Low birth defect.
° Increase the malformation rate 2-3 fold with phenytoin, phenobarbital,carbamazepine.
° Increase dress as high as 4-8 fold with Valproate.
- Effect Of AEDs on Vitamin K:
° VitaminK deficiency.
° Neonatal hemorrhage.
° increased degradation of vitamin k.

Pregnancy complications:


-postpartum hemorrhage.
-postpartum depression.
-increase indication of labour induction.
-developing a seizure disorder of Epileptic mother's children.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2020 Areeba Hameed


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