Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade
Management of seizures often involves continuous medication use throughout a patient’s life, including when a patient is pregnant. The physiological changes during pregnancy can lead to altered drug exposure to anti-seizure medications, increasing patient response variability. In addition, subtherap...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-12-01
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| Series: | Pharmaceutics |
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| Online Access: | https://www.mdpi.com/1999-4923/14/12/2733 |
| _version_ | 1797455711939067904 |
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| author | Charul Avachat Jessica M. Barry Xintian Lyu Catherine M. Sherwin Angela K. Birnbaum |
| author_facet | Charul Avachat Jessica M. Barry Xintian Lyu Catherine M. Sherwin Angela K. Birnbaum |
| author_sort | Charul Avachat |
| collection | DOAJ |
| description | Management of seizures often involves continuous medication use throughout a patient’s life, including when a patient is pregnant. The physiological changes during pregnancy can lead to altered drug exposure to anti-seizure medications, increasing patient response variability. In addition, subtherapeutic anti-seizure medication concentrations in the mother may increase seizure frequency, raising the risk of miscarriage and preterm labor. On the other hand, drug exposure increases can lead to differences in neurodevelopmental outcomes in the developing fetus. Established pregnancy registries provide insight into the teratogenicity potential of anti-seizure medication use. In addition, some anti-seizure medications are associated with an increased risk of major congenital malformations, and their use has declined over the last decade. Although newer anti-seizure medications are thought to have more favorable pharmacokinetics in general, they are not without risk, as they may undergo significant pharmacokinetic changes when an individual becomes pregnant. With known changes in metabolism and kidney function during pregnancy, therapeutic monitoring of drug concentrations helps to determine if and when doses should be changed to maintain similar seizure control as observed pre-pregnancy. This review concentrates on the results from research in the past decade (2010–2022) regarding risks of major congenital malformations, changes in prescribing patterns, and pharmacokinetics of the anti-seizure medications that are prescribed to pregnant patients with epilepsy. |
| first_indexed | 2024-03-09T15:58:16Z |
| format | Article |
| id | doaj.art-4b20441305f8462fb8342a896fca415d |
| institution | Directory Open Access Journal |
| issn | 1999-4923 |
| language | English |
| last_indexed | 2024-03-09T15:58:16Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceutics |
| spelling | doaj.art-4b20441305f8462fb8342a896fca415d2023-11-24T17:21:05ZengMDPI AGPharmaceutics1999-49232022-12-011412273310.3390/pharmaceutics14122733Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past DecadeCharul Avachat0Jessica M. Barry1Xintian Lyu2Catherine M. Sherwin3Angela K. Birnbaum4Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55414, USAExperimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55414, USAExperimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55414, USAExperimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55414, USAExperimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55414, USAManagement of seizures often involves continuous medication use throughout a patient’s life, including when a patient is pregnant. The physiological changes during pregnancy can lead to altered drug exposure to anti-seizure medications, increasing patient response variability. In addition, subtherapeutic anti-seizure medication concentrations in the mother may increase seizure frequency, raising the risk of miscarriage and preterm labor. On the other hand, drug exposure increases can lead to differences in neurodevelopmental outcomes in the developing fetus. Established pregnancy registries provide insight into the teratogenicity potential of anti-seizure medication use. In addition, some anti-seizure medications are associated with an increased risk of major congenital malformations, and their use has declined over the last decade. Although newer anti-seizure medications are thought to have more favorable pharmacokinetics in general, they are not without risk, as they may undergo significant pharmacokinetic changes when an individual becomes pregnant. With known changes in metabolism and kidney function during pregnancy, therapeutic monitoring of drug concentrations helps to determine if and when doses should be changed to maintain similar seizure control as observed pre-pregnancy. This review concentrates on the results from research in the past decade (2010–2022) regarding risks of major congenital malformations, changes in prescribing patterns, and pharmacokinetics of the anti-seizure medications that are prescribed to pregnant patients with epilepsy.https://www.mdpi.com/1999-4923/14/12/2733epilepsyanti-seizure medicationpregnancypharmacokineticspost-partum |
| spellingShingle | Charul Avachat Jessica M. Barry Xintian Lyu Catherine M. Sherwin Angela K. Birnbaum Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade Pharmaceutics epilepsy anti-seizure medication pregnancy pharmacokinetics post-partum |
| title | Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade |
| title_full | Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade |
| title_fullStr | Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade |
| title_full_unstemmed | Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade |
| title_short | Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade |
| title_sort | management of anti seizure medications during pregnancy advancements in the past decade |
| topic | epilepsy anti-seizure medication pregnancy pharmacokinetics post-partum |
| url | https://www.mdpi.com/1999-4923/14/12/2733 |
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