Fatores relacionados ao uso de drogas antiepilépticas em mulheres durante a gestação: revisão de escopo

Abstract

Epilepsy is a non -communicabl e brain disorder that affects approximately 50 million people worldwide, making it one of the most common chronic conditions among women of reproductive age. Pregnant women with epilepsy are at increased risk for various complications, including miscarriag e, pre -and postpartum hemorrhages, hypertensive disorders, and intrauterine growth restriction. Additionally, fetal exposure to antiepileptic drugs contributes to teratogenic complications. Therefore, identifying the potential problems associated with the se drugs can minimize the risk of maternal and fetal complications. Furthermore, this identification will guide healthcare professionals, ensuring that women receive proper counseling and individualized care during pregnancy, contributing to a safer pregna ncy. The aim of this study was to map the available evidence on the factors related to the use of antiepileptic drugs (AEDs) in women during pregnancy. This is a scoping review developed based on the recommendations of the Joanna Briggs Institute (JBI) Man ual. The search for articles was conducted in the Medline/PubMed, Scopus, Web of Science, Embase, CINAHL, Google Scholar, IBICT, and CAPES Theses databases. Articles published between 2000 and 2023, in the public domain and in any language, were included. The process of searching, identifying, and evaluating articles was carried out by two independent reviewers, guided by the assumptions established by JBI, aiming to answer the following guiding question: “What is the a vailable evidence regarding the factor s related to the use of AEDs during pregnancy?” A third reviewer resolved any disagreements. Eighteen articles were selected, showing that monotherapy is a safer approach, as it is associated with a lower risk of congenital malformations and perinatal comp lications, while polytherapy is linked to higher complication rates, such as cesarean sections, seizures, and neonatal complications. The choice of AED should balance seizure control with potential risks to the fetus. Levetiracetam stood out as an effectiv e and safe option, with a lower risk of obstetric and neonatal complications. Additionally, being seizure -free prior to pregnancy is a good indicator of positive outcomes. Continuous monitoring of plasma levels and dose adjustments, as with lamotrigine, ar e essential to ensure the safety of both the mother and the baby. In conclusion, the choice of AED should balance efficacy and safety, with controlling seizures before pregnancy and counseling on family planning being crucial to minimize risks. New studies are needed to improve the safe management of these medications.