Optymalizacja leczenia epilepsji i wyników ciąży: rola monitorowania stężeń leków we krwi

OBJECTIVE: To provide an overview of pharmacokinetic changes of antiseizure medications (ASMs) during pregnancy and postpartum period and to emphasize the role of therapeutic drug monitoring (TDM) in clinical management. METHOD: This is a structured literature review of electronic medical databases PubMed, Cochrane, Google Scholar, and the clinical trial database (clinicaltrials.gov) from inception to March 2026, examining ASMs pharmacokinetic changes during pregnancy and postpartum period in people with epilepsy and the role of TDM in clinical management. RESULTS: There are significant pregnancy-induced alterations in ASM pharmacokinetics, particularly increased ASM clearance, which have reshaped clinical practices and dispelled the notion that seizure exacerbation during pregnancy is the result of ASM ineffectiveness. Instead, understanding these predictable physiological changes is essential to avoid significant pregnancy-induced decreases in ASM serum concentrations that can result in breakthrough seizures. Additionally, individual factors may contribute to significant variability in ASM clearance alterations, and more research is needed to clarify management of different ASMs during pregnancy. Presently, TDM at regular intervals during gestation is gaining prominence and has become an indispensable tool in epilepsy care during pregnancy. Growing evidence supports the critical role of TDM in maintaining seizure control during pregnancy while minimizing fetal ASM exposure. CONCLUSIONS: TDM is an essential tool in the management of epilepsy during pregnancy-postpartum to optimize ASM therapy for seizure control, particularly for several ASMs that have demonstrated significant pharmacokinetic changes. Further research is needed to establish optimal monitoring protocols and characterize the pharmacokinetic changes in newer ASMs during pregnancy.