RT Journal Article SR Electronic T1 Optimal monitoring of anti epileptic drugs in pregnancy: time for a randomised controlled trial? JF Archives of Disease in Childhood - Fetal and Neonatal Edition JO Arch Dis Child Fetal Neonatal Ed FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP Fa120 OP Fa120 DO 10.1136/adc.2011.300163.79 VO 96 IS Suppl 1 A1 S Thangaratinam A1 R Rikunenko A1 L Greenhill A1 M Bagary A1 A Pirie A1 K S Khan A1 D McCorry YR 2011 UL http://fn.bmj.com/content/96/Suppl_1/Fa120.1.abstract AB Background Pregnant women with epilepsy have a tenfold increased risk of mortality compared to other women, with 1 in 250 pregnancies exposed to antiepileptic drugs (AED). The levels of AED fall in pregnancy with a risk of worsening seizures. There is a clinical equipoise regarding the optimal AED monitoring method. Clinicians either regularly check serum levels of AED (therapeutic drug monitoring (TDM)) or adjust the AED dose based on clinical features alone (clinical features monitoring (CFM)). Aim To evaluate the effectiveness of the AED monitoring regimes in pregnancy in reducing seizures. To ascertain the views of epilepsy professionals and pregnant women with epilepsy. Methods We searched MEDLINE (1966–2010), EMBASE (1980–2010) and Cochrane (2009), for citations on the effectiveness of the two monitoring methods in pregnancy. We conducted an online survey of epilepsy professionals and also obtained the views of pregnant women attending the joint epilepsy obstetric clinic. Results Five studies of pregnant women with epilepsy on lamotrigine (n=99) were included. The rate of seizure deterioration was 0.40 (95% CI 0.26 to 0.55) in women monitored by TDM compared to 0.73 (95% CI 0.56 to 0.86) in those monitored by CFM. A total of 27.6% (n=8) of epilepsy specialists practiced TDM, 62.1% (n=18) undertake TDM occasionally and 10.3% (n=3) practiced CFM. Over 96% of women (n=49/51) felt that the question was important for further research. Conclusion Our work in this area has highlighted the need for a large clinical trial to provide definitive evidence.