Linked Life Data

15461670

Source:http://linkedlifedata.com/resource/pubmed/id/15461670

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
10
pubmed:dateCreated
2004-10-5
pubmed:abstractText
A rational approach to the treatment of women of childbearing potential with epilepsy has been hampered by the lack of conclusive data on the comparative teratogenic potential of different antiepileptic drugs (AEDs). Although, several cohort studies on birth defects associated with AED use during pregnancy have been published, these have generally failed to demonstrate differences in malformation rates between AEDs, probably mainly due to insufficient power. In particular, pregnancies with new generation AEDs have been too few. In recent years, pregnancy registries have been introduced to overcome this problem--EURAP (an international collaboration), the North American, and the U.K. AED and pregnancy registries are observational studies that prospectively assess pregnancy outcome after AED exposure using slightly different methods. Each has enlisted 3-5,000 pregnancies in women with epilepsy, and the North American and the U.K. have released preliminary observations. Thus the U.K. registry reported a higher malformation rate with valproate, 5.9% (4.3-8.2%; 95% CI), than with carbamazepine, 2.3% (1.4-3.7%), and lamotrigine, 2.1% (1.0-4.0%). Most of the more recent cohort studies have also identified a nonsignificant trend toward a higher teratogenicity with valproate. These signals need to be interpreted with some caution since none of the studies to date have fully assessed the impact of possible confounders, such as type of epilepsy, family history of birth defects, etc. However, with increasing number of pregnancies it should be possible in the near future for the pregnancy registries to take such confounding factors into account and thus make more reliable assessments of the causal relationship between exposure to specific AEDs and teratogenic risks. While awaiting more conclusive results, it appears reasonable to be cautious in prescribing valproate to women considering to become pregnant if other suitable treatment alternatives, and with less teratogenic potential, are available. Any attempt to change treatment should, however, be accomplished well before conception. The importance of maintained seizure control must also be kept in mind, and the woman who needs valproate to control her seizures should not be discouraged from pregnancy, provided that counseling at the best of available knowledge is given.
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:chemical
pubmed:status
MEDLINE
pubmed:month
Oct
pubmed:issn
0013-9580
pubmed:author
pubmed:issnType
Print
pubmed:volume
45
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
1171-5
pubmed:dateRevised
2006-11-15
pubmed:meshHeading
pubmed-meshheading:15461670-Abnormalities, Drug-Induced, pubmed-meshheading:15461670-Adult, pubmed-meshheading:15461670-Anticonvulsants, pubmed-meshheading:15461670-Carbamazepine, pubmed-meshheading:15461670-Child, pubmed-meshheading:15461670-Cohort Studies, pubmed-meshheading:15461670-Confounding Factors (Epidemiology), pubmed-meshheading:15461670-Epilepsy, pubmed-meshheading:15461670-Female, pubmed-meshheading:15461670-Humans, pubmed-meshheading:15461670-Maternal Welfare, pubmed-meshheading:15461670-Physician's Practice Patterns, pubmed-meshheading:15461670-Pregnancy, pubmed-meshheading:15461670-Pregnancy Complications, pubmed-meshheading:15461670-Pregnancy Outcome, pubmed-meshheading:15461670-Registries, pubmed-meshheading:15461670-Research Design, pubmed-meshheading:15461670-Risk Factors, pubmed-meshheading:15461670-Triazines, pubmed-meshheading:15461670-Valproic Acid
pubmed:year
2004
pubmed:articleTitle
Navigating toward fetal and maternal health: the challenge of treating epilepsy in pregnancy.
pubmed:affiliation
Department of Neurology, Karolinska Hospital, Stockholm, Sweden. torbjorn. tomson@ kus.se
pubmed:publicationType
Journal Article, Comparative Study