engleski

Surveillance of Croatian pregnant women with epilepsy and effects of antiepileptic drugs exposure

Rationale: The teratogenic effects of antiepileptic drugs (AED) exposure in pregnancy have been recognized but the relative risks of new antiepileptic drugs and its long-term neurodevelopmental effects remain poorly understood. The aim of this study was to follow up pregnancies exposed to AED and their offspring in order to assess teratogenic and neurodevelopmental effect of particular AED of newer generation. Methods: The study was designed as a prospective surveillance of pregnancies in Croatian women with epilepsy ranging from May 2003 to May 2008. The pregnancies were registered up to now with complete outcomes in 41 of 47. The data about pregnancy planning, folic acid supplementation, frequency of seizures and AED therapy were obtained. Results: During 5 years we have surveyed 47 pregnancies: 83% (39/47) were exposed to monotherapy: 23 to lamotrigine (LTG): 13 live-births (LB), 2 premature deliveries (one with motor delay), 2 spontaneus abortions (SA), 1 artificial abortion, 1 intrauterine death and 4 ongoing pregnancies (OP). Seven LB were exposed to carbamazepine (CBZ), 1 LB was under phenitoine (PHT) and 1 under phenobarbiton (PB) with EPH gestosis/ peripartal asphyxia. One preterm LB with atrial septal defect, severe psychomotor delay and epilepsy was exposed to gabapentine (GBP), 3 LB and 1 OP were under valproic acid (VP). Two pregnancies were under meprobamate (MPB): 1 LB and 1 SA. Six pregnancies were exposed to polytherapy: 1 LB, 1 SA and 1 OP to topiramate (TPM) and VP ; 1 still-birth to CBZ and PB ; 1 LB with intrauterine growth retardation and dysmorphism to TPM, CBZ, PHT ; and 1 OP to VP and clonazepam (CZP). Two pregnant women with epilepsy were without AED and delivered healthy LB. About 35% of women have planned their pregnancy, but only about 20% have taken folic acid properly (before and during their pregnancies). About 25.5% (12/47) of these women had their second or third pregnancy during our survey. Pregnancy planning in these pregnancies was above 50% due to preconceptional counselling during our survey. Conclusions: We have surveyed pregnancies exposed to LTG, VP, PHT, PB, GBP, TMP, CBZ, MPB and CZP. Pregnancies under polytherapy resulted in larger proportion of complications. Besides 4 spontaneous abortions, 2 still-births, 2 premature deliveries we have noted 1 possible intrauterine AED effect and 1 premature livebirth with atrial septal defect, psychomotor delay and epilepsy. Adequate preconceptional counseling in women with epilepsy resulted in higher proportion of pregnancy planning and folic acid intake. Further follow up of all live-births till school age is needed in order to assess the potential neurodevelopmental effect of AED.

croatia; antiepileptics; pregnant; women

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