Abstracts

Rationale: The teratogenic effects of intrauterine antiepileptic drugs (AEDs) exposure have been recognized but the relative risks of new AEDs and its long-term neurodevelopmental effects remain poorly understood. The aim of this study was to follow up pregnancies exposed to AED and their offspring in order to assess teratogenic and neurodevelopmental effect of particular AED of newer generation. Methods: The study is prospective surveillance of pregnancies in Croatian women with epilepsy from May 2003 to May 2010. The data about pregnancy planning, folate supplementation, frequency of seizures and AED therapy were obtained. Results: During 7 years we have surveyed 70 pregnancies: 5 were without AED (4 LB (live-births), 1 ongoing pregnancy (OP)). About 59 (90.8%) were exposed to monotherapy: 33 to lamotrigine (LTG): 24 LB, 2 premature deliveries (one with motor delay), 3 spontaneous abortions (SA), 1 artificial abortion, 1 intrauterine death and 3 OP. Twelve LB and 2 SA were exposed to carbamazepine (CBZ), 1 LB was under phenitoine (PHT) and 3 under methylphenobarbital (MPB): 1 SA, 1 LB, 1 preterm LB due to EPH gestosis with peripartal asphyxia. One LB and 1 preterm LB with atrial septal defect, severe psychomotor delay and epilepsy was exposed to gabapentine (GBP), 5 LB and 1 OP were under valproic acid (VP). Six pregnancies were exposed to polytherapy: 1 LB, 1 SA and 1 OP to topiramate (TPM) and VP; 1 still-birth to CBZ and PB; 1 LB with intrauterine growth retardation and dysmorphism to TPM, CBZ, PHT; and 1 OP to VP and clonazepam (CZP). About 35% of women have planned their pregnancy, but only about 20% have taken folic acid properly (before and during their pregnancies). About 30% of these women had their second or third pregnancy during our survey. After preconceptional counselling during and after their first pregnancies, pregnancy planning in these subsequent pregnancies was above 50%. Conclusions: We have surveyed pregnancies exposed to LTG, VP, PHT, MPB, GBP, TMP, CBZ and CZP. Pregnancies under polytherapy resulted in larger proportion of complications. Besides 7 spontaneous abortions, 2 still-births, 3 premature deliveries we have noted 1 possible intrauterine AED effect and 1 premature live-birth with atrial septal defect, psychomotor retardation and epilepsy. Adequate preconceptional counseling in women with epilepsy resulted in higher proportion of pregnancy planning and posibility for periconceptional folic acid intake. Further follow up of all live-births is needed in order to assess the potential neurodevelopmental effect of AED.