Background – Why?
In the early 2000’s, results from several antiepileptic drug (AED) pregnancy registries revealed that valproate the highest risks of AEDs for congenital malformations. In addition around the same time, researchers from the NIH NEAD study examined the short and long-term outcomes in babies exposed to four different AEDs during pregnancy. From the NEAD study, we know that valproate also has the highest risks for cognitive and behavioral impairments. In May 2018, a continuation of the NEAD study was published. This time, researchers were curious to learn if the prescribing habits of AEDs in pregnant women had changed since the publication of the NEAD study. Below is a summary of the most recent findings from this MONEAD study.
Research Methods:
The purpose of the MONEAD study is to examine a variety of maternal and child outcomes for presently used AEDs, and is the first study to examine the effects of AED blood levels. The first publication from the MONEAD study sought to demonstrate what AEDs are now being prescribed to pregnant women with epilepsy. Researchers selected different groups of patients to compare the AEDs. These groups were 1) pregnant women with epilepsy, 2) pregnant women without epilepsy, and 3) non-pregnant women with epilepsy. The pregnant women without epilepsy and the non-pregnant women with epilepsy served as “controls.” These groups were considered the standards that the pregnant women with epilepsy were compared against. This type of research design – using control groups – helps to verify that results are statistically significant rather than just left up to chance. Women that participated in this study were from 20 epilepsy centers across the country. Data was collected from December 2012 to January 2016.
Research results- What?
Below are some common prescribing trends that researchers identified when analyzing their data:
Impact of the Research – So what? and Now what?
The results of this research were encouraging – it appears that over the time since the NEAD and other study results were published showing the higher risk of valproate in pregnant patients, there has been a notable decrease in the prescribing of valproate. Lamotrigine and levetiracetam appear to be favorites of prescribers, likely because we have data supporting their lower risk in pregnancy.
You may be asking, “What about other epilepsy medications?” Well, right now we only have pregnancy risk data on 9 of approximately 30 medications used to treat epilepsy. This research study highlights the need for additional research on AEDs. Now, we need healthcare practitioners and researchers alike to continue to explore the safety of AEDs in pregnant women. Consider asking your provider if you can participate in a clinical trial.
Reference; https://www.myepilepsystory.org/from-the-experts/epilepsy-and-pregnancy/
Ahmed, thank you for sharing your post. It is encouraging to learn that there are safer AEDs available to pregnant women now compared to in the early 2000's. I could not imagine being faced with the decision to either take a medication that is potentially teratogenic or take no medication and lose seizure control. I was also happy to hear that the preferred agents in pregnant women included lamotrigine and levetiracetam, both of which are available as generic and affordable for most pregnant women. This is especially helpful information when counseling young women who are trying to get pregnant. (Louise Brown)
Ahmed, you have presented an informative study, so firstly I wanted to thank you for educating all of us! I was not familiar with NEAD or MONEAD study. In practice, I have also experienced that Lamotrigine and Levetiracetam are most commonly prescribed for pregnant patient. I also found it interesting that the MONEAD study included pregnancy women without epilepsy. I also wonder how the author got an approval to include these patient population. Another point I have also observed while practicing is that many female with epilepsy and those who are planning for pregnancy often try to titrate down their dose to discontinue their medication while planning and being pregnant. – Trusha Patel
Ahmed: What I find curious is that there could be an experimental group, pregnant on valproate! Kevin Glick
Your post is touchy and informative at the same time, Ahmed. Touchy in a way that there are so many women out there who have epilepsy and want to get pregnancy. With the result of these studies there is hope for women who have epilepsy and want to get pregnant.
Your research is informative, as I used to think there is no anti-seizure medication that can be used to prevent seizure during pregnancy. Your post has increased my knowledge about the role of anti-seizure medication during pregnancy (Syed Rashid).
Your post is very informative and covers great details of epilepsy during pregnancy...Deepa Pednekar
I referred to this in a previous post. Ensure that all women of child bearing age (with or without epilepsy) are on folic acid to prevent neural tube defects. http://pediatrics.aappublications.org/content/104/2/325 Ruth Nemire