16 July 2008

Women taking antiepileptic drugs and planning a pregnancy are advised to prepare well ahead of conception to reduce the risk of birth defects, according to an article in the current edition of Australian Prescriber.

Associate Professor Cecilie Lander, Department of Neurology at the University of Queensland, states in the article that these women have two to three times more risk than other women of having a baby with a foetal abnormality. Taking more than one antiepileptic drug may carry a greater risk.

“Congenital heart disease, neural tube defects, urogenital defects and cleft lips or palates occur in about three to seven per cent of babies of women with epilepsy who are taking antiepileptic drugs,” Associate Professor Lander writes. In addition, there are concerns that children who have been exposed to these drugs in utero may develop problems such as language impairment and autistic disorders.

Associate Professor Lander therefore recommends pre-pregnancy counselling and a comprehensive management plan. “These women should be treated with the least teratogenic but most efficacious antiepileptic drug for their particular type of epilepsy, at the lowest effective dose,” she writes.

There are particular concerns with valproate. Associate Professor Lander says “valproate should be avoided if possible because of the risk of major malformations”. However, she says there is a delicate balance that clinicians and pregnant mothers must try to achieve when managing the risks of maternal epilepsy and trying to safeguard the health of the unborn child.

She also recommends that all potentially reproductive women with epilepsy take folate supplements, even if they are not currently contemplating pregnancy.

For the complete article visit Australian Prescriber.

ENDS

Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by the National Prescribing Service Limited (NPS), an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing.

For further advice health professionals can also call the Therapeutic Advice and Information Service (TAIS) – a medicines information service staffed by specialist drug information pharmacists – on 1300 138 677 Monday to Friday 9am-7pm Eastern Standard Time for the cost of a local call (mobiles may cost more).