Antiepileptic drugs in pregnancy and risk for the mother and child - an international conference

There is a strong public interest in drug safety and especially in use of drugs in pregnancy. Every year about 300 000 children are born in the Nordic countries, and about 60% of Nordic pregnant women are prescribed drugs during pregnancy, some of them due to chronic diseases that necessitate long-term drug therapy also during the pregnancy. An increasing number of studies have addressed treatment with antiepileptic drugs during pregnancy and adverse outcomes in children, including congenital malformations and impaired neurodevelopment. In particular, maternal use of valproate during pregnancy has been associated with an increased risk of congenital malformations, autism spectrum disorder, poor cognitive skills, attention-deficit/hyperactivity disorder and impaired academic performance. Because of this growing concern regarding the use of valproate in pregnancy, the European Medicine Agency (EMA) has issued a warning on its use; if possible, the use of valproate should be avoided in girls and women of fertile age and should be considered only in girls and women with refractory epilepsy who do not respond to other antiepileptic drugs. The concern increases the need to look into the use of antiepileptic drugs in women of fertile age and especially those who become pregnant. Antiepileptic drugs are used to manage epilepsy; however, especially the newer antiepileptic drugs are also used increasingly in the treatment of psychiatric disorders (e.g. bipolar diseases), migraine, trigeminal neuralgia and neuropathic pain. The many new indications mean that a much larger cohort of fertile/pregnant women are taking antiepileptic drugs, which adds to the pertinence of continuous surveillance of antiepileptic drug use among women of fertile age and pregnant women. A recent study from the Nordic countries, US and Australia showed that the use of antiepileptic drugs in pregnancy rose from 2006 to 2016, and valproate was still the most used antiepileptic drug in Australia.