Updates on Anti-seizure Medication Use in Pregnancy

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• Meador KJ, Cohen M J, Loring DW, et al. Two-year-old cognitive outcomes in children of pregnant women with epilepsy in the maternal outcomes and neurodevelopmental effects of antiepileptic drugs study. JAMA Neurol. 2021;78(8):927–36. Cognitive outcomes at age 2 years were not different between children born to patients with epilepsy and healthy controls.

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•• Vegrim HM, Dreier JW, Alvestad S, et al. Cancer risk in children of mothers with epilepsy and high-dose folic acid use during pregnancy. JAMA Neurol. Published online September 26, 2022. https://doi.org/10.1001/jamaneurol.2022.2977. This review found increased risk of childhood cancers in children exposed to high dose folic acid (defined as >1 mg) compared to those on low dose folic acid born to patients with epilepsy. This raises concern that high dose folic acid may be detrimental.

Pennell PB and Hovinga CA. Chapter 13 Antiepileptic drug therapy in Pregnancy I: gestation-induced effects on AED pharmacokinetics. International Review of Neurobiology, Academic Press, Volume 83, 2008, 227–240.

•• Pennell PB, Karanam A, Meador K, et al. Anti-seizure medication concentrations during pregnancy: results from the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study. JAMA Neurol. 2022;79:370–9. This prospective cohort study found that dose-normalized concentrations of ASMs including lamotrigine, levetiracetam, lacosamide, oxcarbazepine, and zonisamide all significantly decreased during pregnancy.

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