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14 Surveillance of Croatian pregnant women with epilepsy and effects of antiepileptic drugs exposure in their offspring

Published online by Cambridge University Press:  24 June 2014

Snježana Miškov ,
Romana Gjergja Juraški ,
Aleksandra Fučić ,
Tomislav Ivičević Bakuli ,
Ljerka Cvitanović Sojat ,
Vlasta Vuković ,
Vanja Basic Kes  and
Vida Demarin
Snježana Miškov
Affiliation:
Department of Neurology, University Hospital “Sisters of Mercy”, Zagreb, Croatia
Romana Gjergja Juraški
Affiliation:
Department of Pediatrics, University Hospital“Sisters of Mercy”, Vinogradska cesta 29, Zagreb, Croatia
Aleksandra Fučić
Affiliation:
Institute for Medical Research and Occupational Health, Ksaverska c 2, Zagreb, Croatia
Tomislav Ivičević Bakuli
Affiliation:
Department of Obstetrics and Gynecology, University Hospital“Sisters of Mercy”, Vinogradska cesta 29, Zagreb, Croatia
Ljerka Cvitanović Sojat
Affiliation:
Department of Pediatrics, University Hospital“Sisters of Mercy”, Vinogradska cesta 29, Zagreb, Croatia
Vlasta Vuković
Affiliation:
Department of Neurology, University Hospital “Sisters of Mercy”, Zagreb, Croatia
Vanja Basic Kes
Affiliation:
Department of Neurology, University Hospital “Sisters of Mercy”, Zagreb, Croatia
Vida Demarin
Affiliation:
Department of Neurology, University Hospital “Sisters of Mercy”, Zagreb, Croatia
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Abstract

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Introduction:

The aim was to survey pregnancies exposed to AED and their offspring in order to assess teratogenic/ neurodevelopmental effect of newer generation AEDs.

Methods:

This is prospective surveillance of pregnancies in women with epilepsy(May2003-May2008). Pregnancy planning data, folic acid (FA) supplementation, seizure frequency and AED therapy were obtained.

Results:

From 47 pregnancies: 83% (39/47) exposed to monotherapy: 23 to lamotrigine (LTG): 13 live-births (LB), 2 premature deliveries, 2 spontaneous 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 (ASD), severe psychomotor delay and epilepsy) was exposed to gabapentine (GBP), 3LB and 1 OP were under valproic acid (VP). One LB and 1 SA were under phenobarbiton (PB). Six pregnancies were exposed to polytherapy: topiramate (TPM)/VP (1 LB, 1 SA, 1 OP) CBZ/PB (1stillbirth); TPM/CBZ/PHT (1LB) with intrauterine growth retardation and dysmorphism); VP/clonazepam (CZP) (1 OP). Two women without AED therapy delivered healthy LB. From 35% planned pregnancies, 20% took FA properly. About 25.5% of these women had their second or third pregnancy during our survey and their pregnancy planning was above 50%mainly due to preconceptional counseling.

Conclusion:

Pregnancies under polytherapy resulted in larger proportion of complications. Besides 4 SA, 2 still-births, 2 premature deliveries, we have noted 1 possible intrauterine AED effect and 1 premature LB with ASD, psychomotor delay and epilepsy. Adequate preconceptional counseling in women with epilepsy resulted in higher pregnancy planning and FA intake. Follow up of LB till school age is needed.