Topiramate (Topamax) in Pregnancy May Affect Fetal Growth
This is a paper I missed from 2014, but I think this study adds some important information to the review we posted on topiramate a few weeks ago.
Medications and Pregnancy: A Focus on the Pharmacokinetics
We have an abundance of articles which address the impact of psychotropic medications on pregnancy. Much less research, however, has focused on how pregnancy may affect how these medications work. Physiologic changes take place during [...]
Anti-Epileptic Drugs and Risk of Miscarriage
Do anti-epileptic drugs increase the risk for miscarriage and/or stillbirth? Many reports have demonstrated an association between the use of antiepileptic drugs during pregnancy and increased risk of congenital malformations and pregnancy complications, including pre-eclampsia, [...]
Breastfeeding and Anti-Epileptic Medications
Because breastfeeding has many psychological and medical benefits for both the mother and her child, many women would like to breastfeed. However, all medications taken by the mother are secreted into the breast milk. While various studies have addressed the short-term safety of antiepileptic drugs (AEDs) in nursing infants, none have systematically assessed the long-term effects of exposure to these drugs on cognitive development.
Prenatal Exposure to Antiepileptic Drugs Associated with Worse Developmental Outcomes
We have previously written about studies which indicate that prenatal exposure to antiepileptic drugs (AEDs), particularly valproic acid, may adversely affect the developing fetus. Numerous studies have documented long-term effects of antiepileptic exposure on cognitive functioning: prenatal exposure to AEDs has been associated with lower IQs, as well as lower scores on tests of executive functioning, memory, verbal and nonverbal abilities, in children at 6 yeas of age (Meador KJ et al, 2012). These deficits were the most prominent in children exposed to valproic acid.
Outcomes of Children Exposed to Antiepileptic Drugs in Pregnancy: No Good News for Valproate
There have long been concerns regarding the use of the anticonvulsant valproate (Depakote) during pregnancy. First trimester use of valproate has been associated with a 3-5% risk of neural tube defects, as well as an increased risk of other malformations affecting the heart. In addition, recent reports have indicated that in utero exposure to valproate may also result in lower IQ.
From the North American AED Pregnancy Registry: The Newer Anticonvulsants Appear to Be Safer
While it is well-established that several of the older anticonvulsants, including valproate (Depakote), carry a significant teratogenic risk, less is known about the reproductive safety of the newer antiepileptic drugs (AEDs). The North American AED Pregnancy Registry was established in 1997 for pregnant women in the United States and Canada at the Massachusetts General Hospital. The purpose of the registry is to obtain and publish information on the frequency of major malformations among infants whose mothers have taken one or more AEDs during pregnancy.
What’s Safer for Breastfeeding: Lithium or Lamotrigine?
After last week’s post, we received several comments regarding the use of mood stabilizers in breastfeeding women, specifically asking which is safer: lithium or lamotrigine.
Lamotrigine and Breastfeeding: An Update
Women with bipolar disorder are vulnerable to postpartum illness, and it is generally recommended that mothers continue treatment with a mood stabilizer throughout the postpartum period to reduce their risk of relapse; however, this recommendation is complicated by the all mood stabilizers are secreted into the breast milk, although their concentrations appear to vary considerably (Chaudron and Jefferson, 2000).
Lamotrigine and Pregnancy: An Update
While anticonvulsants, such as lamotrigine (Lamictal), topiramate (Topamax), and gabapentin (Neurontin), are being used with increasing regularity for the treatment of women with bipolar disorder, we have limited information with respect to the reproductive safety of the newer anticonvulsant agents. In 2006, we reported on preliminary data indicating an increased risk of oral clefts among infants exposed to lamotrigine during the first trimester of pregnancy.