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From the Department of Neurology (K.J.M.), University of Florida, Gainesville; Emory Epilepsy Program (P.B.P.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (C.L.H.), Weill Cornell Medical College, New York, NY; Epilepsy Therapy Project (J.C.G.), Reston, VA; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Johns Hopkins University School of Medicine (P.W.K.), Baltimore, MD; Neuroscience Center at Dartmouth (G.L.H.), Dartmouth Medical School, Lebanon, NH; New York University (J.A.F.), New York; Columbia University College of Physicians and Surgeons (W.A.H.), New York, NY; University of Toronto (P.G.W.), Ontario, Canada; and Department of Psychiatry (J.A.C.), Yale University School of Medicine, New Haven, CT.
* To whom correspondence should be addressed. E-mail: Kimford.meador{at}emory.edu.
Most pregnant women with epilepsy require antiepileptic drug (AED) therapy. Present guidelines recommend optimizing treatment prior to conception, choosing the most effective AED for seizure type and syndrome, using monotherapy and lowest effective dose, and supplementing with folate. The Epilepsy Therapy Project established the international Health Outcomes in Pregnancy and Epilepsy (HOPE) forum to learn more about the impact of AEDs on the developing fetus, particularly the role of pregnancy registries in studying AED teratogenicity. The primary outcome of interest in these registries is the occurrence of major congenital malformations, with some data collected on minor malformations. Cognitive and behavioral outcomes are often beyond the timeframe for follow-up of these registries and require independent study. The HOPE consensus report describes the current state of knowledge and the limitations to interpretations of information from the various sources. Data regarding specific risks for both older and newer AEDs need to be analyzed carefully, considering study designs and confounding factors. There is a critical need for investigations to delineate the underlying mechanisms and explain the variance seen in outcomes across AEDs and within a single AED.
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  T. Tomson Which Drug for the Pregnant Woman with Epilepsy? N. Engl. J. Med., April 16, 2009; 360(16): 1667 - 1669. [Full Text] [PDF]
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 Antiepileptic Drugs and Pregnancy: Registry Data Journal Watch Neurology, January 6, 2009; 2009(106): 3 - 3. [Full Text]
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 S. Karceski Epilepsy and pregnancy: Are seizure medications safe? Neurology, September 30, 2008; 71(14): e32 - e33. [Full Text] [PDF]
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