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Effects of monitoring strategies on seizures in pregnant women on lamotrigine: a meta-analysis.

Eur J Obstet Gynecol Reprod Biol. 2014 Jan;172:26-31. doi: 10.1016/j.ejogrb.2013.10.021. Epub 2013 Oct 24.

Pirie DA1, Wattar BH2, Pirie AM3, Houston V4, Siddiqua A4, Doug M2, Bagary M5, Greenhill L5, Khan KS6, McCorry D7, Thangaratinam S8.
Author information 1School of Medicine, University of Dundee, UK.2Birmingham Women’s NHS Foundation Trust, Birmingham, UK.3Birmingham Women’s NHS Foundation Trust, Birmingham, UK; University of Birmingham, Birmingham, UK.4University of Birmingham, Birmingham, UK.5Birmingham and Solihull Mental Health NHS Foundation Trust, UK.6Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK.7University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.8Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK. Electronic address: s.thangaratinam@qmul.ac.uk.
Eur J Obstet Gynecol Reprod Biol
ABSTRACT
OBJECTIVES: Pregnant women with epilepsy have a significantly increased risk of mortality and morbidity compared to non-pregnant women. At least one in 250 pregnancies is exposed to anti-epileptic drugs (AED). Seizure deterioration occurs in up to a third of pregnant women. AED levels fall in most pregnant women, although it is uncertain that this is responsible for seizure deterioration rather than a hormonal effect. Current practice of AED monitoring is either therapeutic drug monitoring (TDM) or clinical features monitoring (CFM) to adjust the AED dose. We have systematically reviewed the effectiveness of the two monitoring regimens for AEDs, especially lamotrigine, the most commonly used AED in pregnancy on maternal and fetal outcomes.STUDY DESIGN: We searched MEDLINE (1966-2012), EMBASE (1980-2012) and Cochrane, for relevant citations on the effectiveness of different monitoring strategies on seizure deterioration in pregnant women with epilepsy on lamotrigine. Study selection, quality assessment and data extraction were carried out by two independent reviewers. We calculated the rates of deterioration in seizures with the two strategies and pooled the estimates with random effects meta-analysis.RESULTS: Six observational studies (n=132) evaluated the effectiveness of the two monitoring strategies on pregnant women with epilepsy on lamotrigine. There were no randomised controlled trials. The rate of seizure deterioration was 0.30 (95% CI 0.21-0.41) in women monitored by therapeutic drug monitoring (TDM) compared to 0.73 (95% CI 0.56-0.86) in those receiving clinical feature monitoring (CFM) alone.CONCLUSION: Evidence based on observational data suggests that monitoring of AED levels in pregnancy reduces seizure deterioration, although the included studies have numerous sources of bias. There is paucity of evidence to make firm recommendations on optimal monitoring of AED drugs in pregnancy. Further research is needed to advise on the best clinical practice in managing AED in pregnancy.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Full Text Source: Elsevier Science
PMID:24211103 | http://www.ncbi.nlm.nih.gov/pubmed/24211103

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