Abstracts

Young women with epilepsy are eager to enjoy full productive lives including bearing children. There has long been a fear regarding the effect of the pregnancy on seizures and the effect of epilepsy and its treatment on the fetus/infant. Over the last five years numerous registries have been developed within the USA and globally to evaluate the effects of AEDs on pregnancy outcomes (North American Registry, EURAP, Australian and UK Registries ). We evaluated our pregnancy outcomes before and after the approval of the new AEDs., Questionnaires were sent to women in our practice who were pregnant between 1995 and the present. Questions and information were given in written format and by telephone communication. Women who wished to participate signed consents and returned the information in pre-stamped return packets. Also included was a self-addressed, prepaid envelope to receive a complete report from the authors when the project is finished. Questions regarding all pregnancies were asked including age, folate use, AED use, seizures during pregnancy, delivery type, any birth/delivery complications, fetal loss, ultrasound results, and developmental status of the child with each pregnancy. For this study, [ldquo]old AEDs[rdquo] were defined as those approved prior to 1990 and [ldquo]new AEDs[quot] were those approved after 1990., 98 questionnaires were sent out 38% have been returned thus far. 24 patients have reported information on 32 pregnancies, one with twins. 16 babies (48%) were exposed to old AEDs, 13 (39%) to new AEDs; 4 to polytherapy with old AEDs (12%). AEDs were CBZ 30%, PB 3%, PHT 3%, VPA 3%, GBP 3%, LTG 15%, LEV 12%, OXC 3%, TPM 3%. Polytherapy was PB + VPA in 2, CBZ + LTG in 1, CBZ + PB in 1. There were 29 (88%) live births. Chromosomal abnormalities were present in 2 of 4 unsuccessful pregnancies: 1 tubal (CBZ + PB), 1 stillbirth (CBZ), and 2 miscarriages (CBZ, LEV)). 13 women had seizures at some time during pregnancy: 3 had a single GTC, 8 had CPS [plusmn] SPS, 2 had only SPS. There were no cases of status. There were no major congenital abnormalities. Folate was supplemented in 62% of live births at doses between 1-4 mg/day. There were 8 (28%) abnormal outcomes in the live birth group defined as delayed development for speech or motor milestones, requiring therapy and special programming. All abnormal outcomes were seen in mothers on monotherapy and occurred with folate supplementation: 5 (62%) were with old AEDs and 3 (37%) were with new AEDs: 3 with CBZ, 3 with LTG, 1 with PB, 1 with VPA., Women with epilepsy can have successful pregnancies without fear of major malformations. More subtle developmental delays and need for early special services and therapy for the child may be more prevalent than previously recognized with both old and new AEDs. Awareness of this potential concern may direct a choice in AED(s), as well as allow the parents to advocate for the child earlier.,