If a patient is on a med like tegretol and is greater than 7 wks don't change it to a new one. By 7 weeks the hazards have already affected the fetus sure more effect mostly minor will happen later. A single agent is better than multiple agents. What I mean is this if a patient has alreday been exposed to one drug and her seizures are controlled and you change her to a safer drug you just exposed the fetus to now 2 drugs that could potentiate effects, of course there are some exceptions please see below. This is for informative purposes only.
EXCERPT From uptodate:
Over 90 percent of women with epilepsy will have good outcomes but preconception counseling is important for all women of child bearing years because many pregnancies are unplanned and the risks of complications can be minimized by interventions before and early on in pregnancy. This should include information regarding risks associated with epilepsy and pregnancy, potential interactions with oral contraceptive therapy, and recommended folate supplementation. The MRC vitamin study (which excluded women with epilepsy) demonstrated that folic acid supplementation (4 mg per day) starting before pregnancy was associated with a 72 percent reduction in the incidence of neural tube defects in women at high risk because of a previously affected pregnancy.
Necessity for antiepileptic drugs — There are two issues that must be considered concerning the administration of antiepileptic drugs (AEDs) in any woman with a seizure disorder who wants to become pregnant:
Is the diagnosis of epilepsy well established? In some patients, routine EEG recordings or continuous video/EEG monitoring may be warranted to confirm the diagnosis. Does the patient require AEDs(antiepileptic drugs) and if so, is she on the most appropriate medication(s) and at the minimum dose to maintain seizure control? Many physicians will consider withdrawal of AEDs after a period of two years without seizures
Choice of antiepileptic drug — If it is felt that medications cannot be withdrawn, the patient should take the most suitable medication for the seizure type.
The optimal treatment of women with epilepsy who are of childbearing age is unclear because of a lack of conclusive data on the comparative teratogenicity of different AEDs. A number of pregnancy registries are beginning to accumulate data that should help guide therapy in the coming years.
At present, we recommend the following approach. AED therapy should be optimized prior to conception, if possible, before exposure of the fetus to potential teratogenic effects of AEDs. Since there is no agreement as to which AED is most or least teratogenic, the AED that stops seizures in a given patient is the one that should be used. A possible exception is valproate. Early results from pregnancy registries and most recent cohort studies suggest a trend toward higher teratogenicity with valproate than with other AEDs.
The DRUGS:
The AED should be administered at the lowest dose and lowest plasma level that protects against tonic-clonic and/or complex partial seizures.
The plasma drug level should be monitored regularly during pregnancy including, if available, the physiologically important free or unbound drug concentration.
The use of multiple agents should be avoided, if possible, especially combinations involving valproate, carbamazepine, and phenobarbital. If there is a family history of neural tube defects, both valproate and carbamazepine should be avoided, unless a patient's seizures cannot otherwise be controlled
In established pregnancy, changes to alternate AED therapy should not be undertaken solely to reduce teratogenic risk for several reasons :
- Changing AEDs may precipitate seizures.
- Overlapping AEDs during the change exposes the fetus to effects of an additional AED.
- There is limited advantage to changing AEDs if pregnancy has already been established for several weeks.
Antiepileptic Drug Pregnancy Registry — The Antiepileptic Drug Pregnancy Registry (
Toll-free:1-888-233-2334; online at
www.massgeneral.org/aed) is a North American registry for pregnant women who are taking any AED. The registry's purpose is to collect data to assess the fetal risk from AEDs and to provide information about pregnancy issues to patients with epilepsy and their physicians.
MANAGEMENT DURING PREGNANCY AND DELIVERY — Management during pregnancy consists of folic acid supplementation, screening for major malformations, monitoring plasma AED levels, and the administration of vitamin K late in pregnancy.
Hope this helps
🙂 Diane
