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Background <p>Evidence of the safety of some anti-seizure medicines (ASMs) during pregnancy remains uncertain.</p> Methods <p>We conducted a population-based cohort study of singleton pregnancies in Scotland conceived between 01/04/2010-02/07/2023. Exposure was ‘any ASM’ prescription issued 28 days prior to conception up to pregnancy end. Seven monotherapies were also examined: valproate, topiramate, carbamazepine, lamotrigine, levetiracetam, gabapentin and pregabalin. Unexposed comparators were matched to the exposed on gestational age and year of conception. Pregnancy loss, congenital condition and child development outcomes were compared by exposure status using conditional logistic regression to account for the matched study design.</p> Results <p>Here we show pregnancy loss (3175/11,011 pregnancies, 28.8% vs. 24,040/107,889 pregnancies, 22.3%), congenital conditions (230/8370 babies, 2.7% vs. 1693/82,085 babies, 2.1%) and developmental concerns (1270/4890 live births, 26.0% vs. 7658/48,883 live births, 15.7%) are more common following any ASM exposure in pregnancy compared with no ASM exposure in pregnancy. Valproate is strongly associated with pregnancy loss (adjusted odds ratio (aOR): 1.92, 95% confidence interval (CI): 1.50-2.47), congenital conditions (aOR: 1.85, 95% CI: 1.06-3.21) and developmental concerns (aOR: 1.43, 95% CI: 1.01-2.03). Pregabalin, gabapentin and any ASM are also associated with pregnancy loss and developmental concerns.</p> Conclusions <p>Our findings corroborate the associated risks of valproate use and embryo malformations, support the use of lamotrigine and levetiracetam in pregnancy and raise concerns regarding gabapentinoid use in pregnancy.</p>

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Pregnancy, baby, and childhood outcomes from using anti-seizure medication during pregnancy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月18日

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  • Emily Moore,
  • Morven Millar,
  • Rachel Merrick,
  • Tanja Mueller,
  • Victoria Stark,
  • Lynne Jarvis,
  • Amanj Kurdi,
  • Leanne Hopkins,
  • Stuart McTaggart,
  • Rute Vieira,
  • Marion Bennie,
  • Rachael Wood

摘要

Background

Evidence of the safety of some anti-seizure medicines (ASMs) during pregnancy remains uncertain.

Methods

We conducted a population-based cohort study of singleton pregnancies in Scotland conceived between 01/04/2010-02/07/2023. Exposure was ‘any ASM’ prescription issued 28 days prior to conception up to pregnancy end. Seven monotherapies were also examined: valproate, topiramate, carbamazepine, lamotrigine, levetiracetam, gabapentin and pregabalin. Unexposed comparators were matched to the exposed on gestational age and year of conception. Pregnancy loss, congenital condition and child development outcomes were compared by exposure status using conditional logistic regression to account for the matched study design.

Results

Here we show pregnancy loss (3175/11,011 pregnancies, 28.8% vs. 24,040/107,889 pregnancies, 22.3%), congenital conditions (230/8370 babies, 2.7% vs. 1693/82,085 babies, 2.1%) and developmental concerns (1270/4890 live births, 26.0% vs. 7658/48,883 live births, 15.7%) are more common following any ASM exposure in pregnancy compared with no ASM exposure in pregnancy. Valproate is strongly associated with pregnancy loss (adjusted odds ratio (aOR): 1.92, 95% confidence interval (CI): 1.50-2.47), congenital conditions (aOR: 1.85, 95% CI: 1.06-3.21) and developmental concerns (aOR: 1.43, 95% CI: 1.01-2.03). Pregabalin, gabapentin and any ASM are also associated with pregnancy loss and developmental concerns.

Conclusions

Our findings corroborate the associated risks of valproate use and embryo malformations, support the use of lamotrigine and levetiracetam in pregnancy and raise concerns regarding gabapentinoid use in pregnancy.