Optymalizacja leczenia padaczki u kobiet w wieku rozrodczym i podczas ciąży: porównanie praktyki ogólnopolskiej z opieką specjalistyczną w poradniach epilepsji w Polsce
Optimizing antiseizure treatment in women of reproductive age and during pregnancy: Nationwide practice versus specialized epilepsy care in Poland
W skrócie
Badanie porównywało, jakie leki przeciwpadaczkowe otrzymują kobiety w wieku rozrodczym i w ciąży - w całej Polsce i w specjalistycznej poradni epilepsji. Okazało się, że w poradni specjalistycznej znacznie rzadziej przepisywano niebezpieczne dla płodu leki, zwłaszcza kwas walproinowy, natomiast częściej stosowano bardziej bezpieczne opcje. Wyniki pokazują, że specjalistyczna opieka epilepsyjna pomaga wybierać bezpieczniejsze leczenie dla kobiet planujących ciążę lub już będących w ciąży.
Oryginalny abstract (angielski)
PURPOSE: To compare antiseizure medication (ASM) treatment patterns among women with epilepsy (WWE) of reproductive age and pregnant WWE using nationwide administrative data and a university epilepsy referral center cohort in Poland. METHODS: This retrospective study analyzed two complementary datasets. Nationwide data were obtained from the Polish National Health Fund, including 44,951 WWE aged 20-49 years in 2024 and 594 pregnant WWE who delivered in 2022. Referral center data were collected from medical records of 277 WWE aged 20-49 years treated in 2024 and 112 pregnancies managed between 2019 and 2026. RESULTS: Levetiracetam and lamotrigine were the most frequently prescribed ASMs in both cohorts. Compared with the nationwide population, women of reproductive age treated at the epilepsy center were significantly less likely to receive valproate (18.4 % vs. 31.1 %, p < 0.001) or carbamazepine (6.5 % vs 16 %p < 0.001), while lacosamide, brivaracetam, and cenobamate were prescribed more frequently. The proportion of women receiving monotherapy was similar in both cohorts. Among pregnant WWE, non-valproate monotherapy predominated in both groups but was significantly more common at the referral center (77.7 % vs. 62.0 %, p < 0.001). Valproate use during pregnancy was markedly lower in the referral center than in the nationwide cohort (2.7 % vs. 16.0 %, p < 0.001), whereas levetiracetam and lamotrigine use was comparable. CONCLUSIONS: Women managed at an epilepsy referral center were substantially less likely to receive potentially teratogenic ASMs, particularly valproate, despite representing a more clinically complex population. These findings highlight the contribution of specialized epilepsy care to optimizing pharmacological management for women of reproductive age and during pregnancy while supporting adherence to contemporary treatment recommendations.