AEDs and pregnancy

Question 1

increased risk of teratogenicity associated with the use of antiepileptic drugs especially if used during

Answer 1

first trimester and particularly if the patient is taking two or more antiepileptic drugs

Question 2

All pregnant females with epilepsy, whether taking medication or not, should be encouraged to notify the

Answer 2

UK Epilepsy and Pregnancy Register

Question 3

all pregnant females with epilepsy mmust notify the UK Epilepsy and Pregnancy Register - true or false

Answer 3

false - they should be encouraged to notify them, whether they take meds or not

Question 4

can females taking AED monotherapy BF

Answer 4

yes should generally be encouraged to

Question 5

can females taking AED combination therapy BF

Answer 5

if a female is on combination therapy or if there are other risk factors, such as premature birth, close monitoring is recommended.
Patients and their family should be made aware of signs of toxicity in the infant and advised to seek medical advice if these occur.

Question 6

all infants who are breastfed by mother who takes AED should be monitored for… (4)

Answer 6

sedation, feeding difficulties, adequate weight gain, developmental milestones

Question 7

infants being BF by mother who takes AED should also be monitored for adverse effects associated with the AED, esp with newer AEDS, if the AED is readily transferred into breast milk causing high infant serum drug conc (e.g. …..4…..)
or if flower metabolism in infant causes drugs to accumulate (e.g. ….2….)

Answer 7

ethosuximide, lamotrigine, primidone, and zonisamide

phenobarbital and lamotrigine

Question 8

Serum-drug concentration monitoring should be undertaken in breast-fed infants if …..

If toxciity develops, it may be necessary to ….

Answer 8

suspected adverse reactions develop

introduce formula feeds to limit the infant’s drug exposure, or to wean the infant off breast-milk altogether.

Question 9

these 3 are associated with an established risk of drowsiness in breast-fed babies and caution is required.

Answer 9

Primidone, phenobarbital, and the benzodiazepines

Question 10

Withdrawal effects may occur in infants if a mother suddenly stops breast-feeding, particularly if she is taking (3)

Answer 10

phenobarbital, primidone, or lamotrigine

Question 11

safest drug in pregnancy

Answer 11

lamotrigine
also levetiracetam

Question 12

with any AED used during pregnancy, the following are recommended where possible

Answer 12

monotherapy and use of the lowest effective dose

Question 13

plasma conc of AED (esp these two …….) can be affected by physiological changes during pregnancy and postpartum

Answer 13

lamot and pheny

Question 14

valproate must not be used in females of childbearing potential unless

Answer 14

conditions of PPP are met and alt treatments ineffective or not tolerated

Question 15

valproate must NOT be used during pregnancy unless

Answer 15

no other suitable alternative

Question 16

prescribers should also carefully consider the choice of AEDs in pre-pubescent girls who may later become pregnant. females of CBP who take AED should be given advice above….

Answer 16

the need for a highly effective contraception method to avoid unplanned pregnancy

Question 17

AED interacctions with hormonal contraceptives

Answer 17

Some antiepileptic drugs can reduce the efficacy of hormonal contraceptives, and the efficacy of some antiepileptics may be affected by hormonal contraceptives.
May need to use methods of contraception that are not affected e.g. coil, IUD etc.

Question 18

what to do if unplanned pregnancy is discovered

Answer 18

specialist advice should be sought
the risk of harm to the mother and fetus from convulsive seizures outweighs the risk of continued therapy

Question 19

the likelihood of a female who is taking AEDs having a baby with no malformations is at least …. so it is improtant that…

Answer 19

at least 90%, and it is important that female patients do not stop taking essential treatment because of concern over harm to the fetus.

Question 20

to reduce risk of neural tube defects, the following is advised throughout the 1st trimester

Answer 20

folate supplementation

Question 21

female pt who have seizures in 2nd half of pregnancy need to be assessed for ….

Answer 21

eclampsia before any change is made to antiepileptic treatment

Question 22

routine injection of vit K at birth minimises risk of…

Answer 22

neonatal haemorrhage associated with antiepileptics

Question 23

Valproate MHRA latest advice

Answer 23

• do not start in new pt (M or F) under 55 UNLESS two specialists independently consider and document that there is no other effective or tolerated treatment, or there are compelling reasons why the reproductive risks do nto aply
• at the next annual specialist review, females of CBP should be reviewed using a revised valproate Risk Aknowledgement Form which will include need for a second specialist signature if pt is to continue with valproate; subsequent annual reviews with one specialist should be carried out unless pt siutation changes
• need to be in accordance with PPP

Question 24

why is it that valproate must not be started in new patients (MALE or female) aged under 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment, or there are compelling reasons why the reproductive risks do not apply - why males?

Answer 24

evolving info about potential risk of impaired fertility in male pt on valproate
increased risk of neurodevelopmental disorders in children of men who took valproate