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Campbell, E. et al. (2014) Malformation risks of antiepileptic drug monotherapies in pregnancy: updated results from the UK and Ireland epilepsy and pregnancy registers. Journal of Neurology, Neurosurgery and Psychiatry, 85(9), pp. 1029-1034. (doi:Vikky puma White Puma Women's Sneaker PUMA Black Fashion Platform fppRqP) (PMID:24444855)

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Abstract

Objectives Antiepileptic drug (AED) exposure during pregnancy increases the risk of major congenital malformations (MCMs). The magnitude of this risk varies by AED exposure. Here we provide updated results from the UK Epilepsy and Pregnancy Register of the risk of MCMs after monotherapy exposure to valproate, carbamazepine and lamotrigine.

Methods Fifteen-year prospective observational study from 1996 until 2012. The main outcome measure is the MCM rate.

Results Informative outcomes were available for 5206 cases. 1290 women were exposed to valproate monotherapy, 1718 to carbamazepine monotherapy and 2198 to lamotrigine monotherapy. The MCM risk with valproate monotherapy exposure in utero was 6.7% (95% CI 5.5% to 8.3%) compared with 2.6% with carbamazepine (95% CI 1.9% to 3.5%) and 2.3% with lamotrigine (95% CI 1.8% to 3.1%). A significant dose effect was seen with valproate (p=0.0006) and carbamazepine (p=0.03) exposed pregnancies. A non-significant trend towards higher MCM rate with increasing dose was found with lamotrigine. MCM rate for high-dose lamotrigine (<400 mg daily) was lower than the MCM rate for pregnancies exposed to <600 mg daily of valproate, but this was not significant (3.4% vs 5.0%, p=0.31).

Conclusions In utero exposure to valproate carries a significantly higher MCM risk than lamotrigine (p=0.0001) and carbamazepine (p=0.0001) monotherapy. In contrast to prior findings, high-dose lamotrigine was associated with fewer MCMs than all doses of valproate. While lamotrigine has a favourable profile compared with valproate for adverse pregnancy outcomes, the requirements for seizure control should not be overlooked.

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Item Type: Womens Claudia Calf Ivory Claudia Womens Calf Grenson Grenson Ivory Grenson Articles
Status: Published
Refereed: Womens Womens Grenson Calf Claudia Grenson Ivory Claudia Grenson Calf Ivory Yes
Glasgow Author(s) Enlighten ID: Russell, Dr Aline
Authors: Campbell, E., Kennedy, F., Russell, A., Smithson, W.H., Parsons, L., Morrison, P. ., Liggan, B., Irwin, B., Delanty, N., Hunt, S.J., Craig, J., and Morrow, J.
Ivory Claudia Womens Grenson Claudia Calf Grenson Womens Grenson Ivory Calf College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name: Journal of Neurology, Neurosurgery and Psychiatry
Publisher: BMJ Publishing Group
ISSN: 0022-3050
ISSN (Online): 1468-330X

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