Antiseizure Drugs Pregnancy Trends
Antiseizure Medication Use in Pregnancy Shifts Towards Safer Options, But risks Remain
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New research reveals a significant decline in the use of high-risk antiseizure medications (ASMs) during pregnancy, alongside an increase in safer alternatives. However, challenges persist, especially for socially deprived populations.
Paris, France – A thorough study analyzing prescription data from 2013 to 2021 has illuminated a notable shift in the landscape of antiseizure medication (ASM) use among pregnant individuals. The findings, published in Neurology, indicate a substantial decrease in exposure to ASMs with known teratogenic risks, such as valproic acid and valpromide. Concurrently, there has been a marked increase in the adoption of ASMs considered safer for prenatal exposure, including lamotrigine and levetiracetam.
despite these positive trends, the study highlights ongoing concerns regarding the use of ASMs with uncertain risks and the disproportionate burden faced by women from lower socioeconomic backgrounds.
Declining Use of High-Risk ASMs and Rising Safer Alternatives
The period between 2013 and 2021 witnessed a dramatic reduction in prenatal exposure to valproic acid and valpromide, with declines of 84% and 89%, respectively.This trend was accompanied by a corresponding increase in pregnancy terminations by 23% and 28% for these medications. Furthermore, the study observed a drastic fall in sustained live birth exposures to valproic acid and valpromide, decreasing by 86% and 91% for valproic acid, and 93% and 96% for valpromide, respectively.
in contrast, the use of ASMs categorized as the safest options, lamotrigine and levetiracetam, saw a significant rise of 30%. The study also noted an increase in the use of ASMs with uncertain risks, up by 33%, with notable surges in pregabalin (+49%) and gabapentin (+27%). Newer ASMs experienced an even more substantial growth of 140%.
Persistent Challenges and Socioeconomic disparities
While the overall trend favors safer medication choices, the use of carbamazepine and topiramate, ASMs with acknowledged risks, decreased to a lesser extent, by 40% and 34%, respectively. Between 2019 and 2021, nearly 600 newborns were exposed to each of these medications.
A critical finding of the study revealed significant socioeconomic disparities in ASM exposure. Among women with a low level of resources, exposure to ASMs with uncertain or acknowledged risks was higher (18.5% and 17.9%, respectively) compared to exposure to the safest ASMs or unexposed individuals (13.8% and 13.5%, respectively).
The study also identified a correlation between the use of lamotrigine, frequently enough prescribed for mood disorders, and an increase in termination rates (+51% lamotrigine use linked to a +35% rise in termination rates). Terminations also saw an increase in association with ASMs carrying acknowledged risks.
Expert Recommendations and Future Directions
The authors of the study emphasize the need for continued efforts to mitigate prenatal exposure to ASMs with acknowledged or uncertain risks. “Additional measures are needed to further reduce perinatal exposure to ASMs with acknowledged or uncertain risks, especially among the most socially deprived populations,” they stated.
This research underscores the importance of ongoing monitoring and targeted interventions to ensure the safest possible outcomes for both mothers and their children, particularly for vulnerable populations.
Study Methodology and Limitations
The study analyzed prescription data from 2013 to 2021, encompassing maternal age (15-49 years) and socioeconomic status assessed via health insurance. Diagnoses were confirmed using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. Maternal and pregnancy characteristics, alongside ASM treatment patterns, were examined over the entire study period and by subperiods (2013-2015, 2016-2018, and 2019-2021). The primary outcome was the temporal change in prenatal ASM exposure rates across safety categories, analyzed by year, diagnosis, and social indicators.The study’s reliance on prescription claims to determine ASM exposure and the absence of data on clinical indications for treatment represent its primary limitations. However,prior research utilizing this dataset has supported its reliability for assessing prenatal ASM exposure.