The latest results from the UK Epilepsy and Pregnancy Register were presented at the recent European Congress on Epileptology meeting in Madrid.
Groups such as Epilepsy Action have long advocated the need for pre-conception counselling for women with epilepsy before thinking about starting a family. This enables women to be stabilised on a suitable anti-epileptic drug (AED) to control seizures, while posing the minimum possible risk to their unborn child. However, the major question was which AEDs were most suitable?
The Register was set up in 1996 to try and overcome the lack of data, and to determine the relative risks of major congenital malformations due to exposure of the unborn child to AEDs during pregnancy.
To date, 2,028 pregnancies have been monitored and results from a further 594 pregnancies are still awaited. So far, the crude rates for risk of malformation women on one AED are 4 per cent and women on more than one AED 6.3 per cent.
In terms of individual drugs, the risk for carbamazepine is 2.3 per cent, the risk for sodium valproate is 7.2 per cent and the risk for lamotrigine is 3 per cent. Although the results so far show carbamazepine and lamotrigine to have a lower risk than valproate, only carbamazepine can be shown at this stage to be significantly different.
More women are needed to sign up to the Register because the more births that are monitored, the more accurately trends can be assessed. Women who are considering pregnancy can then be advised which drugs will pose the lowest possible risks, enabling them to make an informed choice about their medication.
Any women with epilepsy in the UK who become pregnant can join the Register by telephoning Freephone 0800 389 1248. An epilepsy specialist nurse or answerphone takes the call and the Register then contacts the woman's GP to follow up the results of the pregnancy.