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Antiepileptics in pregnancy

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https://www.readbyqxmd.com/read/29763992/development-of-an-algorithm-to-identify-pregnancy-episodes-and-related-outcomes-in-health-care-claims-databases-an-application-to-antiepileptic-drug-use-in-4-9-million-pregnant-women-in-france
#1
Pierre-Olivier Blotière, Alain Weill, Marie Dalichampt, Cécile Billionnet, Myriam Mezzarobba, Fanny Raguideau, Rosemary Dray-Spira, Mahmoud Zureik, Joël Coste, François Alla
PURPOSE: Access to claims databases provides an opportunity to study medication use and safety during pregnancy. We developed an algorithm to identify pregnancy episodes in the French health care databases and applied it to study antiepileptic drug (AED) use during pregnancy between 2007 and 2014. METHODS: The algorithm searched the French health care databases for discharge diagnoses and medical procedures indicative of completion of a pregnancy. To differentiate claims associated with separate pregnancies, an interval of at least 28 weeks was required between 2 consecutive pregnancies resulting in a birth and 6 weeks for terminations of pregnancy...
May 15, 2018: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/29754108/knowledge-of-women-issues-and-epilepsy-among-doctors-in-sudan
#2
Awab K Elnaeim, Mohamed K Elnaeim, Ismat B A Babiker
OBJECTIVE: The objective of this study was to assess the knowledge of doctors in Sudan about women issues related to epilepsy. METHODS: In this cross-sectional study that was conducted in Sudan during the period from October 2017 to December 2017, we used Google forms to collect data from 154 doctors using Knowledge of Women Issues and Epilepsy (KOWIE) II standardized questionnaire. RESULTS: Our studied group included house officers (n = 34), medical officers (n = 60), registrars (n = 52), and specialists (n = 8)...
May 10, 2018: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/29737274/antiepileptic-drug-monitoring-in-pregnancy-empire-a-double-blind-randomised-trial-on-effectiveness-and-acceptability-of-monitoring-strategies
#3
Shakila Thangaratinam, Nadine Marlin, Sian Newton, Annalise Weckesser, Manny Bagary, Lynette Greenhill, Rachel Rikunenko, Maria D'Amico, Ewelina Rogozińska, Andrew Kelso, Kelly Hard, Jamie Coleman, Ngawai Moss, Tracy Roberts, Lee Middleton, Julie Dodds, Angela Pullen, Sandra Eldridge, Alexander Pirie, Elaine Denny, Doug McCorry, Khalid S Khan
BACKGROUND: Pregnant women with epilepsy on antiepileptic drugs (AEDs) may experience a reduction in serum AED levels. This has the potential to worsen seizure control. OBJECTIVE: To determine if, in pregnant women with epilepsy on AEDs, additional therapeutic drug monitoring reduces seizure deterioration compared with clinical features monitoring after a reduction in serum AED levels. DESIGN: A double-blind, randomised trial nested within a cohort study was conducted and a qualitative study of acceptability of the two strategies was undertaken...
May 2018: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29730500/changes-in-antiepileptic-drug-prescribing-patterns-in-pregnant-women-with-epilepsy
#4
Kimford J Meador, Page B Pennell, Ryan C May, Elizabeth Gerard, Laura Kalayjian, Naymee Velez-Ruiz, Patricia Penovich, Jennifer Cavitt, Jaqueline French, Sean Hwang, Alison M Pack, Maria Sam, Eugene Moore, Dominic M Ippolito
OBJECTIVE: We analyzed current prescribing patterns for antiepileptic drugs (AEDs) in pregnant women with epilepsy (PWWE) at 20 USA tertiary epilepsy centers. METHODS: The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an NIH-funded, prospective, observational, multicenter investigation of pregnancy outcomes for both mother and child, which enrolled women from December 2012 to January 2016. Inclusion criteria for PWWE included ages 14-45 years and up to 20 weeks gestational age...
May 3, 2018: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/29727483/the-role-of-ethnicity-on-pregnancy-outcomes-in-women-with-epilepsy-the-need-for-specific-research
#5
Nanya Hao, Janet Graham, Alison Hitchcock, Terence J O'Brien, Frank J E Vajda
The role of ethnicity on pregnancy outcomes of women with epilepsy (WWE) has received little research attention but is important to guide management. The aim of this review is to identify and describe current knowledge of ethnicity for WWE giving birth. Literature searches were performed with the following terms: ethnic/race combined with epilepsy/seizure, antiepileptic drugs (AED), and/or pregnancy, and combined them with congenital malformation, birth outcome, or pregnancy complication, with English language restriction in PubMed, EMBASE, and Web of Science...
May 4, 2018: Epilepsia
https://www.readbyqxmd.com/read/29719929/the-effect-of-parity-on-risk-of-complications-in-women-with-epilepsy-a-population-based-cohort-study
#6
Kim C Danielsson, Ingrid Borthen, Nils Erik Gilhus, Nils-Halvdan Morken
INTRODUCTION: Women with epilepsy have increased risk of complications in pregnancy with consequences for the mother and child. There are no studies on the influence of parity on complications in women with epilepsy. MATERIAL AND METHODS: This was a population-based cohort study of all first and second births in the Medical Birth Registry of Norway 1999-2013. Risks were estimated, and complication rates compared in distinct women with epilepsy treatment categories...
May 2, 2018: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/29714593/risk-of-cleft-lip-and-or-palate-associated-with-antiepileptic-drugs-postmarketing-safety-signal-detection-and-evaluation-of-information-presented-to-prescribers-and-patients
#7
Bita Rezaallah, David John Lewis, Hans-Florian Zeilhofer, Britt-Isabelle Berg
BACKGROUND: The aim was to analyze safety data associated with the maternal use of antiepileptic drugs in pregnancy and to assess the risk of cleft lip and/or palate (CL/P) as an outcome in the neonate. A parallel objective was to assess the completeness of the safety information concerning pregnancy exposures in the Summary of Product Characteristics (SmPCs) and the Patient Information (PI) in the USA and the UK. METHODS: We analyzed individual case safety reports of CL/P associated with antiepileptic drugs in the FDA Adverse Event Reporting System...
January 1, 2018: Therapeutic Innovation & Regulatory Science
https://www.readbyqxmd.com/read/29712790/nmda-receptor-signaling-is-important-for-neural-tube-formation-and-for-preventing-antiepileptic-drug-induced-neural-tube-defects
#8
Eduardo B Sequerra, Raman Goyal, Patricio A Castro, Jacqueline B Levin, Laura N Borodinsky
Failure of neural tube closure leads to neural tube defects (NTDs), which can have serious neurological consequences or be lethal. Use of antiepileptic drugs (AEDs) during pregnancy increases the incidence of NTDs in offspring by unknown mechanisms. Here we show that during Xenopus laevis neural tube formation, neural plate cells exhibit spontaneous calcium dynamics that are partially mediated by glutamate signaling. We demonstrate that N-methyl-D-aspartate (NMDA) receptors are important for the formation of the neural tube and loss of their function induces an increase in neural plate cell proliferation and impairs neural cell migration, which result in NTDs...
April 30, 2018: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/29700085/valproate-life-saving-life-changing
#9
Rhys H Thomas
Antiepileptic medications, and valproate principally, are commonly prescribed teratogens. There is significant concern that we are not doing enough to educate clinicians and potential parents about the risks of valproate in pregnancy. There is clear advice from the Medicines and Healthcare products Regulatory Agency and the International League Against Epilepsy about the risks of valproate exposure in utero Reviews and guidelines that are focused on fetal risk, however, fall short in being able to fully replicate the complexity of a real clinical decision...
April 1, 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/29691249/hypertensive-pregnancy-complications-in-women-with-epilepsy-and-antiepileptic-drugs-a-population-based-cohort-study-of-first-pregnancies-in-norway
#10
Kim Christian Danielsson, Ingrid Borthen, Nils-Halvdan Morken, Nils Erik Gilhus
OBJECTIVES: To estimate the risk of hypertensive pregnancy complications in women with epilepsy, with and without antiepileptic drugs, and assess the risk associated with the four most common antiepileptic drugs. DESIGN: A population-based cohort study using linked data from the Medical Birth Registry of Norway and the Norwegian Prescription Database. Women with epilepsy with and without antiepileptic drugs were compared with women without epilepsy. SETTING: Norway, 2004-2012...
April 24, 2018: BMJ Open
https://www.readbyqxmd.com/read/29680205/comparative-risk-of-major-congenital-malformations-with-eight-different-antiepileptic-drugs-a-prospective-cohort-study-of-the-eurap-registry
#11
Torbjörn Tomson, Dina Battino, Erminio Bonizzoni, John Craig, Dick Lindhout, Emilio Perucca, Anne Sabers, Sanjeev V Thomas, Frank Vajda
BACKGROUND: Evidence for the comparative teratogenic risk of antiepileptic drugs is insufficient, particularly in relation to the dosage used. Therefore, we aimed to compare the occurrence of major congenital malformations following prenatal exposure to the eight most commonly used antiepileptic drugs in monotherapy. METHODS: We did a longitudinal, prospective cohort study based on the EURAP international registry. We included data from pregnancies in women who were exposed to antiepileptic drug monotherapy at conception, prospectively identified from 42 countries contributing to EURAP...
April 18, 2018: Lancet Neurology
https://www.readbyqxmd.com/read/29674237/eslicarbazepine-acetate-exposure-in-pregnant-women-with-epilepsy
#12
Raquel Costa, Luís M Magalhães, Joana Graça, Mariana Vieira, Helena Gama, Joana Moreira, José F Rocha, Patrício Soares-da-Silva
PURPOSE: Epilepsy is a common neurologic disorder requiring continued treatment during pregnancy. Treatment with antiepileptic drugs (AEDs) is needed for seizure control, but the risk of adverse events has to be minimized for both mother and foetus. Available data on pregnancy and foetal/postnatal outcomes following eslicarbazepine acetate (ESL) exposure via parent is herein presented for the first time. METHODS: ESL's global safety database was reviewed to identify pregnancy cases with exposure to ESL reported up to October 21st, 2017...
April 10, 2018: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/29667177/adverse-placental-effects-of-valproic-acid-studies-in-perfused-human-placentas
#13
Miriam Rubinchik-Stern, Miriam Shmuel, Jacob Bar, Michal Kovo, Sara Eyal
OBJECTIVE: In utero exposure to valproic acid (VPA) has been associated with worse pregnancy outcomes compared to all other antiepileptic drugs. We have previously shown that VPA alters the expression of placental transporters for hormones and nutrients in vitro and in pregnant mice. Here, our aim was to characterize the effects of short exposure to VPA on the expression of carriers for compounds essential for fetal development in human placentas ex vivo, under controlled conditions...
April 17, 2018: Epilepsia
https://www.readbyqxmd.com/read/29661925/changing-antiepilepsy-drug-prescribing-trends-in-women-with-epilepsy-in-the-uk-and-ireland-and-the-impact-on-major-congenital-malformations
#14
Michael O Kinney, James Morrow, Chris C Patterson, Ellen Campbell, Aline Russell, Henry W Smithson, Linda Parsons, Patrick J Morrison, Rebecca Bromley, Brenda Liggan, Norman Delanty, Beth Irwin, Stephen J Hunt, John J Craig
OBJECTIVES: After 20 years of data collection, pregnancy registers have informed prescribing practice. Various populations show trends for a reduction in valproate prescribing, which is associated with an increased risk of anatomical teratogenesis and neurodevelopmental effects in those exposed in utero. Our aim was to determine if any shifts in prescribing trends have occurred in the UK and Ireland Epilepsy and Pregnancy Register cohort and to assess if there had been any change in the overall major congenital malformation (MCM) rate over time...
April 16, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/29661353/recurrent-pyroglutamic-acidosis-related-to-therapeutic-acetaminophen
#15
REVIEW
Hazem M Alhourani, Aneel Kumar, Lekha K George, Tahira Sarwar, Barry M Wall
Pyroglutamic acid, an intermediate in glutathione metabolism, can lead to elevated anion gap metabolic acidosis as rare complication of acetaminophen therapy in adults. Acquired pyroglutamic acidosis has been observed primarily in settings associated with glutathione deficiency. Risk factors for glutathione deficiency include critical illness, chronic liver or kidney disease, advanced age, female gender, alcohol abuse, malnutrition, pregnancy, antiepileptic drugs, and chronic acetaminophen use. Diagnosis of pyroglutamic acidosis requires both the exclusion of common etiologies of increased anion gap metabolic acidosis and a high index of suspicion...
April 2018: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/29625554/antiepileptic-drug-exposure-in-pregnancy-and-pregnancy-outcome-from-national-drug-usage-data
#16
Noni Richards, David Reith, Michael Stitely, Alesha Smith
BACKGROUND: Antiepileptic drugs (AEDs) are used by pregnant women to manage conditions such as epilepsy and bipolar disorder even though they pose a risk to the developing foetus. This study aimed to determine the overall use of AEDs by women during their childbearing years and women who are pregnant and the association between AED use and rates of pregnancy termination and spontaneous abortion. METHODS: Retrospective population based cohort study using administrative databases in New Zealand between 2008 and 2014...
April 6, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29610328/ectopic-neurogenesis-induced-by-prenatal-antiepileptic-drug-exposure-augments-seizure-susceptibility-in-adult-mice
#17
Atsuhiko Sakai, Taito Matsuda, Hiroyoshi Doi, Yukiko Nagaishi, Kiyoko Kato, Kinichi Nakashima
Epilepsy is a neurological disorder often associated with seizure that affects ∼0.7% of pregnant women. During pregnancy, most epileptic patients are prescribed antiepileptic drugs (AEDs) such as valproic acid (VPA) to control seizure activity. Here, we show that prenatal exposure to VPA in mice increases seizure susceptibility in adult offspring through mislocalization of newborn neurons in the hippocampus. We confirmed that neurons newly generated from neural stem/progenitor cells (NS/PCs) are integrated into the granular cell layer in the adult hippocampus; however, prenatal VPA treatment altered the expression in NS/PCs of genes associated with cell migration, including CXC motif chemokine receptor 4 ( Cxcr4 ), consequently increasing the ectopic localization of newborn neurons in the hilus...
April 2, 2018: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/29588970/prevalence-risk-factors-and-neurobehavioral-comorbidities-of-epilepsy-in-kenyan-children
#18
Charles J Kind, Charles R J C Newton, Symon M Kariuki
Objective: To investigate the prevalence, risk factors, clinical features, and neurobehavioral comorbidities of epilepsy and acute symptomatic seizures in school-aged children in Kilifi, Kenya. Methods: Randomly selected children (N = 11,223) were screened for epilepsy and other neurodevelopmental disorders. Those who screened positive were invited for further clinical, electroencephalographic (EEG), and neuropsychological evaluations. Prevalence was measured by dividing cases by screened population, providing Agresti-Coull confidence intervals (CIs)...
December 2017: Epilepsia Open
https://www.readbyqxmd.com/read/29588327/educational-attainment-of-children-born-to-mothers-with-epilepsy
#19
Arron S Lacey, William Owen Pickrell, Rhys H Thomas, Mike P Kerr, Cathy P White, Mark I Rees
OBJECTIVE: Small prospective studies have identified that children exposed to valproate in utero have poorer scores on cognitive testing. We wanted to identify whether children exposed to antiepileptic drugs (AEDs) in utero have poorer school performance. METHODS: We used anonymised, linked, routinely collected healthcare records to identify children born to mothers with epilepsy. We linked these children to their national attainment Key Stage 1 (KS1) tests in mathematics, language and science at the age of 7 and compared them with matched children born to mothers without epilepsy, and with the national KS1 results...
March 27, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/29549194/emilia-romagna-study-on-pregnancy-and-exposure-to-antiepileptic-drugs-espea-a-population-based-study-on-prescription-patterns-pregnancy-outcomes-and-fetal-health
#20
Barbara Mostacci, Francesca Bisulli, Elisabetta Poluzzi, Guido Cocchi, Carlo Piccinni, Alessandra Curti, Giuliana Simonazzi, Gianni Astolfi, Nicola Rizzo, Corrado Zenesini, Roberto D'Alessandro, Paolo Tinuper
OBJECTIVES: To assess the prevalence of antiepileptic drug (AED) exposure in pregnant women and the comparative risk of terminations of pregnancy (TOPs), spontaneous abortions, stillbirths, major birth defects (MBDs), neonatal distress and small for gestational age (SGA) infants following intrauterine AED exposure in the Emilia Romagna region, Italy (4 459 246 inhabitants on 31 December 2011). METHODS: We identified all deliveries and hospitalised abortions in Emilia Romagna in the period 2009-2011 from the certificate of delivery assistance registry (Certificato di Assistenza al Parto- CedAP) and the hospital discharge card registry, exposure to AEDs from the reimbursed drug prescription registries, MBDs from the regional registry of congenital malformations, and Apgar scores and cases of SGA from the CedAP...
March 16, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
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