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Call for safer epilepsy drugs for pregnant women

15 April, 2002

Epilepsy drugs given to women during pregnancy can treble the risk of congenital malformation or developmental delay in their children, according to research in the Journal of Medical Genetics.

Stopping treatment for epilepsy during pregnancy is not an option, but there is an urgent need to develop safer drugs, conclude the researchers. Six in every 1000 pregnancies will be to a woman treated with epilepsy drugs.

One hundred and forty nine mothers being treated with antiepileptic drugs were studied. In all, they had 293 children whose health and neurological development were assessed. Thirty eight of these children had not been exposed to epilepsy treatment while in the womb, either because the mothers did not take the drugs, or epilepsy had not been diagnosed at the time.

The exposed children were significantly more likely to have a high rate of childhood complications than those whose mothers had not taken anti-epileptic drugs during the pregnancy.

One in five had symptoms of drug withdrawal after birth, including feeding problems, seizures, and low blood glucose levels. Congenital malformations, particularly hernias, but also hip dislocation, heart disease, cleft palate and abnormal genital development, were three times as common among the children whose mothers had taken anti-epileptic treatment during pregnancy. And almost one in five children had developmental or speech delays - more than five times the rate among children not exposed during the pregnancy.

Almost a third of the children had either abnormalities that required surgery or developmental delays. Around half had some facial characteristics associated with exposure to epilepsy drugs, a rate that was double that of children who had not been exposed to these drugs.

And over 30 per cent had medical problems in early childhood. One in four had behavioural disorders, including autism, compared with 5 per cent of those not exposed to these drugs.

The study made some allowance for a possible family history of developmental delays. But even in the absence of a family history of learning disorders, 28 per cent of children whose mothers had been treated with epilepsy drugs had developmental problems. In the general population up to 7 per cent of 3 to 5 year olds would normally be affected.

Higher doses of carbamazepine conferred a greater risk. And greater risks were associated with taking more than one anticonvulsant drug during pregnancy.

The authors conclude that the rate of complications and neurological problems in children exposed to anticonvulsant drugs while in the womb is high. Women treated with antiepilepsy drugs need to be counselled and given better information before pregnancy so that they are aware of the potential effects of these drugs on the unborn child, they say.

In response, the epilepsy charity British Epilepsy Association (BEA) is urging all women with epilepsy planning a pregnancy to seek pre-conception counselling, including a clear and understandable explanation of their anti epilepsy drug option during their pregnancy. BEA stresses that all women with epilepsy should see their GP before changing their epilepsy medication and under no circumstances should they stop taking epilepsy medication as this could be potentially harmful to their health and their unborn child.

Philip Lee, Chief Executive of BEA said:

"It is essential that women with epilepsy seek preconception counselling before considering pregnancy. This is so they can be stabilised on an appropriate anti epileptic drug to control seizures while posing the least risk to the unborn child. GPs should regularly review the anti epileptic treatment of women with epilepsy in order to ensure appropriate treatment, not just rely on giving them repeat prescriptions."

A recent study by BEA highlighted that women with epilepsy are not receiving important information about treatment that could have profound implications for their health and the health of their unborn child. 61 per cent of the women who already had children were taking an older anti epilepsy drug* with a known risk of defects; yet less than half of them (45 per cent) remember being told that their medication may affect the unborn child. Indeed, 22 per cent were not given any information about pregnancy and epilepsy medication.