Twenty-year trends in the use of anti-seizure medication among pregnant women in the Netherlands

Anti-seizure medications (ASMs) are used to treat conditions such as epilepsy and bipolar disorder. Some of these drugs are associated with an increased risk of congenital malformations and adverse developmental outcomes. Therefore, PHARMO Institute’s Eline Houben, along with fellow researchers, examined trends in use of ASMs among pregnant women in the Netherlands, according to medication safety profile. The medication safety profiles were categorized as safests ASMs, ASMs of uncertain risk, and ASMs with higher risk. Additionally, switching patterns were assessed.

In total, 671,709 pregnancies among 446,169 women were selected from the PHARMO Perinatal Research Network between 1999 and 2019. 2405 (3.6 per 1000) of those women were ASM-exposed. Over the study period, a significant increase was observed for use of known safest ASMs (0.7-18.0 per 10,000 pregnancies) as well as for those with uncertain risk (5.3-13.4 per 10,000 pregnancies). Use of ASMs with higher risk of congenital malformations decreased significantly (24.8-14.5 per 10,000 pregnancies), except for topiramate (0-6.7 per 10,000 pregnancies). Switches between ASM safety risk categories before and during pregnancy were uncommon; women rather discontinued treatment or switched within the same category.

This study showed that there has been an increase in use of known safest ASMs among pregnant women, together with a trend toward newer ASMs with uncertain risk over the last two decades. Only a small proportion of women switched to a safer alternative before or during pregnancy, which altogether highlights the need for an expansion of ASM risk knowledge and communication to healthcare providers and women of reproductive age to improve preconception counselling.

The full article can be read using this link: Twenty-year trends in the use of anti-seizure medication among pregnant women in the Netherlands – PubMed (


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