Prescribing Practices of Antiseizure Medications at US Academic Medical Centers for Pregnant People With and Without Epilepsy.

Abstract

To assess the recent prescribing practices for antiseizure medications (ASMs) to pregnant people with and without epilepsy and prescribers' preferences beyond the first-line ASMs for patients with refractory generalized epilepsy. A retrospective survey extracted electronic medical data from 20 US tertiary centers (January 1, 2021-December 31, 2022) on ASM prescriptions in pregnant people with and without epilepsy. A second survey asked epileptologists for next-line ASM choices after lamotrigine and levetiracetam failure in women with generalized epilepsy. The final analyses included 17 centers, 378,808 pregnant people who were prescribed ASMs-12,908 with and 365,900 without epilepsy. Key findings include the following: (1) benzodiazepines represented the most prescribed ASM group (12.13%); (2) gabapentin was the second most prescribed ASM (4.16%); (3) among pregnant people with epilepsy, levetiracetam (28.28%), lamotrigine (15.61%), and gabapentin (11.12%) were most frequent exposures; (4) other common ASMs in this group included topiramate (5.86%), oxcarbazepine (3.32%), lacosamide (2.93%), and zonisamide (2.90%); and (5) valproate use was high, with 492 (3.81%) epilepsy exposures and 1,419 overall. Thirty-two US epileptologists survey responders selected zonisamide and lacosamide as second-line ASM choices for female patients with generalized epilepsy. Valproate use in pregnancy remains high despite its known teratogenicity. Many commonly used ASMs in pregnancy have inadequate safety information.