ACC, the Ministry of Health, the Health Quality & Safety Commission and Foetal Anti-Convulsant Syndrome New Zealand (FACS NZ) are encouraging health professionals to discuss the benefits and risks of taking antiepileptic medicine during pregnancy with their female patients who are sexually active.
Antiepileptic medicines are prescribed for epilepsy, mood regulation and pain management. The benefits and risks during pregnancy are known. However, the reduction in prescriptions for women of child-bearing age is less than hoped, especially of sodium valproate. It’s important that female patients are aware of both the benefits and risks of this type of medication, especially if they’re potentially sexually active. The harm to the unborn child happens in the very early stages of pregnancy, often before women are even aware they’re pregnant.
It’s important that patients are included in the decision making around their treatment. They need to know they’re on the best medication for them, understand the possible side effects and avoid unplanned pregnancy.
While there are risks with all antiepileptic medicine, risks are greatest with sodium valproate – the reported rate of congenital malformations is up to 24% with high doses greater than 1500mg per day, compared with 2-3% in the general population. Children born to mothers taking doses of sodium valproate greater than 800mg a day in pregnancy have an average decrease in IQ of 7-10 points and are eight times more likely to require educational intervention when they’re six years old.
These risks can only be reduced by decreasing the dose or changing the medicine, but this must be balanced against the risk to the woman, especially if they have epilepsy. If there is a loss of seizure control, this can have a negative effect on the unborn child, including hypoxia or miscarriage. It can also mean a significant deterioration in the quality of life for the mother and substantially increase her risk of death.
While prescribers and dispensers have steps they can take to minimise risk, there is a very delicate balance that needs to be struck.
It’s important to talk to patients of child-bearing age, and their parents or guardians if they’re minors, about their options. They might not be thinking about pregnancy when this discussion happens, so they may find this conversation quite confronting. It is important that they understand the benefits and risks to make an informed decision that is right for them.
To help with these conversations, two booklets have been created, one for health professionals and one for their female patients, which are available at www.acc.co.nz/treatmentsafety.