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New research is helping the 1 in 50 women who take anti-seizure medications (ASMs) during pregnancy better understand the potential risks to their babies. D r Alex Berry-Noronha, a trainee neurologist and Neurological Foundation VJ Chapman Fellow, is leading a major study to inform and support women taking ASMs through pregnancy. Having trained in Christchurch, Alex is completing his fellowship at the University of Melbourne’s Epilepsy Research Centre – home to some of the world’s leading experts in epilepsy and pregnancy. “Most women with epilepsy have a normal pregnancy and a healthy baby,” says Alex, who also works directly with patients as a clinical neurologist. “But because the effects of many medications on the unborn foetus haven’t been studied extensively, most clinicians will try to avoid these during pregnancy. That then raises the possibility of the underlying condition causing complications. “In the case of epilepsy, untreated seizures themselves can be very harmful, both for the mother and the unborn foetus, so it is always a challenging decision.” Importantly, only about half of pregnant women taking ASMs have epilepsy. The medications are also prescribed for migraines, mental health conditions, and other issues – areas often under-represented in research. Some patients also take multiple ASMs, adding further complexity. To address this, Alex is using a statistical method called meta-analysis to pool data from 75 high-quality studies, covering nearly 17 million live births. He is focusing on poor foetal growth – a lesser-studied but serious complication linked to ASM exposure in utero. Poor foetal growth can increase birth complications and lead to long-term challenges, including poorer academic and employment outcomes. His early findings, published in the prestigious journal Neurology , suggest certain ASMs are linked to growth issues, even in women without epilepsy. However, not all ASMs carry the same risk. “There is consistency in certain ASMs coming up again and again as having higher risks, while others appear to be consistently safe. That is helpful for clinicians to see and discuss with patients,” Alex says. “The real challenge,” he adds, “is when the safer treatments don’t work for patients with more difficult- to-treat cases and we need to use other medications. “Improving our knowledge of the drugs helps us better communicate these risks and empower the women who are taking them to make the best choices before or during pregnancy.” Alex recently presented his findings at the European Epilepsy Congress in Rome, thanks to a Neurological Foundation travel grant. “It’s a major international conference attended by the superstars of epilepsy research,” Alex says. “It was a really humbling platform to present my research, as well as compare ideas with other researchers for future projects.” The VJ Chapman Fellowship encourages trainee neurologists like Alex to gain research experience and bring new skills back to New Zealand that will directly benefit patients. His work is part of a broader legacy supported by the Jim and Bev Barker family, who shared these words: “We are very pleased to be able to support the wonderful research work done by so many dedicated people through the assistance of the Neurological Foundation. We continue to support Alex and wish him every success in his chosen field." Epilepsy New Zealand provides support and information for people with epilepsy – visit their website at epilepsy.org.nz “In the case of epilepsy, untreated seizures themselves can be very harmful, both for the mother and the unborn foetus...” VJ Chapman Fellow Dr Alex Berry-Noronha Headlines 17