Determining which epilepsy drugs are safe to using during pregnancy is important to most women who suffer from the condition, just as is any medicine taken while pregnant. It is becoming more evident that some anti-epileptic drugs are safer to use than others during pregnancy, with valproate being probably the biggest concern.
Recent studies, including one published this week, haven’t yet found an algorithm for deciding which one is best for a given patient. For now, the decision lies with the individual’s clinician’s judgment and the patient’s tolerance to risk for both herself and her child.In the newest study, appearing online n Neurology, compared neurodevelopmental outcomes at ages 3 to 4 in 44 children born to women who took valproate, 53 exposed in utero to levetiracetam (Keppra), and 131 whose mothers were not epileptic and did not take AEDs per Med Page Today.
In past studies, children with fetal exposure to valproate in utero showed significant language and motor skill impairments relative to the no-AED control group, reported Rebekah Shallcross, PhD, of the University of Liverpool in England.
Valproate holds a Pregnancy Class D designation because it is known to increase the risk of birth defects, and a prospective study published last year in Lancet Neurology from the ongoing NEAD project found that 6-year-olds exposed to valproate in utero had diminished IQs, in comparison to children of mothers who took other AEDs during pregnancy.
This study doesn’t necessarily tell all. In fact, it was partly funded by levetiracetam’s manufacturer, UCB, Pharama, which has also paid speaking fees to Shallcross Several other AED manufacturers also supported the study. The study also did not address perinatal outcomes such as congenital defects, preterm birth, or low birth weight.
When it comes to proving which epilepsy drugs are safe during pregnancy, it appears avoiding valproate is your safest bet.