The increasing number of pregnancies among women with chronic conditions, particularly those with epilepsy, has brought new challenges to prenatal care. A recent study conducted by researchers at Charité-Universitätsmedizin Berlin, analyzing data from the German Embryotox cohort, sheds light on the changing patterns of antiseizure medication (ASM) use during the first trimester of pregnancy.
The study, published in Scientific Reports, evaluated ASM use from 2000 to 2018 among 3,763 pregnancies, including 2,395 women diagnosed with epilepsy. Researchers found significant shifts toward the use of safer antiseizure medications, as well as troubling trends concerning the continued use of teratogenic drugs like valproate.
Since 2014, healthcare providers have been cautioned extensively about the risks of valproate—a primarily effective ASM for generalized seizures—particularly for women of childbearing age. Although newer ASMs have emerged with improved safety profiles, many women remain on high-risk medications. By the end of the study, around 13% of women were still prescribed non-recommended ASMs during their early pregnancy.
One of the most notable developments from this research was the rise in the usage of lamotrigine and levetiracetam: these safer alternatives have seen their share increase dramatically. Specifically, researchers observed the proportion of women using lamotrigine rose from 14% to 70.1% during the analysis period. This is particularly pertinent as lamotrigine is deemed one of the safer options for seizure management during pregnancy.
Despite these positive trends, the fact remains alarming—6% of women switched ASMs during early pregnancy, and 4% discontinued their medication entirely. This indicates the potential for instability among women receiving treatment for epilepsy, especially as changing medications during pregnancy could increase the risk of seizures. The study indicated higher discontinuation rates were observed particularly among women using valproate, raising questions about adherence to established treatment guidelines.
Adding complexity to the conversation, there was also a reported increase from 19% to 39% of ASM use for non-epilepsy indications between 2000 and 2018. This expanded use of ASMs is being linked primarily to psychiatric disorders—including bipolar disorder, which often relies upon medications like lamotrigine.
"The significant rise in non-epilepsy indications for lamotrigine may be explained by its preference over teratogenic lithium for the treatment of bipolar disorder," states the research team.
Encouragingly, the study confirms the general shift away from highly teratogenic options, aligning with recommendations to prioritize medications with lower risks of developmental toxicity. This builds upon previous international data, indicating growing awareness and change among healthcare practitioners. Yet, there remains room for improvement.
Research indicates nearly 65% of women with epilepsy experience unplanned pregnancies, underscoring the urgency for comprehensive reproductive health counseling at all stages. Most women continued their treatments as advised, yet the persistence of non-recommended ASMs highlights gaps in the assurance of safety for both maternal and fetal health. Factors contributing to the sustained use of these medications remain unclear—whether it is due to medical inertia or patients’ lack of awareness of safer alternatives.
The demand for effective counseling, therapeutic continuity, and education among healthcare providers is clearer than ever, particularly for those managing epilepsy. Continual discussions about reproductive health, contraception, and medication safety should remain priorities for healthcare providers when working with women of childbearing age.
Importantly, the researchers call for action, emphasizing the necessity to improve preconception counseling and regularly engage with patients about the risks and management of ASM during pregnancy. Improved awareness among healthcare professionals dealing with non-seizure indications is equally necessary for protecting pregnant women from unnecessary medication risks. This proactive approach could significantly contribute to improved outcomes for both mothers and their children.
