Patterns of antiseizure medication use in pregnant women with epilepsy: a 24-year observation in Poland.

Aim of study: The aim of this study was to examine trends in the usage of antiseizure medications (ASM) in pregnant women with epilepsy (WWE) in Poland across 24 years.

Clinical rationale for study: Most WWE continue ASM treatment during pregnancy. Over recent decades, third-generation ASMs with different safety profiles have become available. Understanding the long-term trends could provide valuable information for improving clinical practice guidelines.

Material and methods: The study is based on prospectively collected data from an institutional database of a tertiary epilepsy centre between 2000 and 2024. Data on ASM use during pregnancy was recorded at conception and each trimester. Trends in ASM use in monotherapy and polytherapy were analysed. The study included 1,454 completed pregnancies with a known outcome and a mean maternal age of 28.99 years.

Results: WWE were exposed to 19 different ASMs in monotherapy or polytherapy. Lamotrigine (LTG), valproate (VPA), carbamazepine (CBZ) and levetiracetam (LEV) accounted for 82% of all ASMs. Between 2000 and 2024, there was a statistically significant decrease in the usage of CBZ (Exp(B) = 0.92; p < 0.001; 8% annually) and of VPA (Exp(B) = 0.95; p = 0.005, 5% annually) and an increase in the use of LTG (Exp(B) = 1.03; p = 0.086; 3% annually) and of LEV (Exp(B) = 1.19; p < 0.001; 19% annually). More than two-thirds of the women were on monotherapy, both at conception and throughout pregnancy. WWE not exposed to ASMs accounted for 13.9% at conception and 10.5% in all trimesters. There was a significant increase in the number of women receiving polytherapy across all trimesters over time (Exp(B) = 1.02; p = 0.052; 2% annually) and a decrease in untreated women across all trimesters over time (Exp(B) = 0.97; p = 0.033; 3% annually). The mode of treatment at conception did not change statistically over time.

Conclusions/clinical implications: The use of specific ASMs h as c hanged s ignificantly in th e 21 st ce ntury, wi th a no table decrease in the usage of CBZ and VPA in favour of LEV and LTG. There is an increasing trend towards polytherapy across all trimesters, but not at the conception point.