The Risk of Withdrawal Seizures & Other Adverse Events in Newborns Associated with Levetiracetam Use as Monotherapy or in Combination Therapy for Seizures During Pregnancy - A Systematic Review

Abstract

Introduction: Epilepsy is a neurological disorder that can affect pregnant women, and the use of anti-epileptic drugs during pregnancy must be carefully evaluated. This systematic review aims to assess the risk of withdrawal seizures and other adverse events in newborns when pregnant women with seizures are treated with levetiracetam compared to other treatments.
Methods: Multiple online scientific databases including PubMed, PubMed Central, Ovid MEDLINE, CINAHL, the Cochrane Central Register of Controlled Trials, Web of Knowledge, PsycINFO, and Scopus. The studies were chosen based on the developed inclusion and exclusion criteria. The quality of articles retrieved was assessed by the Robins I-tool for non-randomized trials and a standard Excel data extraction sheet was used to extract data from relevant studies.
Results & Discussion: Out of the 211 studies obtained from database searches and registers, only 11 met the inclusion criteria and were included in this systematic review. A total of 4726 patients were included in this systematic review. The studies were from different geographical regions and countries. The study found that AED polytherapy increased the risk of adverse pregnancy outcomes, including congenital malformations, intrauterine growth restriction, and preterm delivery, and recommended the use of AED monotherapy whenever possible to minimize these risks. Levetiracetam was found to be a safe alternative to other AEDs during pregnancy. The study also established the safety of AED use during lactation, but monitoring of AED levels is essential.
Conclusion: Levetiracetam and other AEDs as monotherapy treatment during pregnancy are generally safe and effective for women with epilepsy. AED polytherapy should be avoided, and treatment choices should be individualized to minimize adverse events.