A Pilot Study of Prophylactic Management of Lamotrigine in Pregnant Women

March 8, 2024 updated by: Johns Hopkins University

A Pilot Study of Prophylactic Management of Lamotrigine for Bipolar Disorder in Pregnant Women

Pregnant women who are taking lamotrigine will be evaluated monthly during pregnancy including a clinical evaluation and a blood draw for lamotrigine levels at each visit. Based on the Therapeutic Drug Monitoring protocol, participant's lamotrigine dosing will be adjusted as needed based on participant's blood levels compared to the reference concentration that was obtained prior to pregnancy or early in pregnancy while clinically stable. After delivery participant and participant's infants will be assessed for mood and functioning at 1, 2, 4, and 6 weeks postpartum.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Studies have demonstrated that at least 80% of women who stop mood stabilizing medications for pregnancy relapse psychiatrically. However, relapse is also quite common in women who continue taking mood stabilizing medication with studies demonstrating approximately a 30-37% relapse rate-most with depressive episodes. One likely explanation for the high relapse rate of Bipolar Disorder during pregnancy despite continued mood stabilizing medication is decreasing blood levels of mood stabilizing medications during the course of pregnancy. Pregnancy induces both pharmacokinetic and pharmacodynamic changes, which can result in decreased serum blood levels and decreased treatment efficacy. Therapeutic drug monitoring is considered standard of care for a number of psychiatric medications. Therapeutic drug monitoring can be an especially crucial guide to clinical treatment during pregnancy, but remarkably, there are no established protocols for the monitoring of levels and dosing of psychiatric medications in pregnancy. Most pregnant psychiatric patients are therefore managed based on symptom recurrence. In contrast, there are established protocols for monitoring blood levels and prophylactic management of antiepileptic medications for epilepsy, including lamotrigine which is also a mood stabilizing medication. The investigators will collect pilot data on the psychiatric outcomes, adverse events, and obstetrical and infant outcomes of pregnant women with Bipolar Disorder who undergo prophylactic therapeutic drug monitoring for a commonly used mood stabilizing medication during pregnancy- lamotrigine. In the epilepsy literature, there is a published protocol for lamotrigine management before, during, and after pregnancy for seizure control; the investigators will use this protocol as a guide.

Study Type

Observational

Enrollment (Estimated)

20

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • United States
    • Maryland
      • Baltimore, Maryland, United States, 21205
        • Recruiting
        • 550 N Broadway
        • Contact:
          • Kelsey Hannan
        • Principal Investigator:
          • Lindsay Standeven, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

16 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Pregnant women who are currently taking Lamotrigine for Bipolar Disorder, Major Depressive Disorder, Schizoaffective Disorder, or another psychiatric illness, and plan to continue throughout pregnancy.

Description

Inclusion Criteria:

  • pregnant, prior or 20 weeks
  • currently taking Lamotrigine and plan to continue throughout pregnancy
  • history of Bipolar Disorder, Major Depressive Disorder, Schizoaffective Disorder or other psychiatric illness, currently stable
  • may be taking other psychiatric medications

Exclusion Criteria:

  • suicidal/clinically unstable
  • alcohol, marijuana, or other drug dependence in last 90 days

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Case-Only
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Taking Lamotrigine
Lamotrigine (Lamictal), dosage will be based on a reference concentration of blood-serum levels
Drug: Lamictal
Blood-serum levels will be checked monthly during pregnancy and reference concentration will be maintained
Other Names:
  • Lamotrigine

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Mood as assessed by The Edinburgh Postnatal Rating Scale
Time Frame: Monthly, after enrollment, up to 10 months
Self-reported experience of depressive symptoms over the past 7 days, each item is scored 0-3 (0=not experiencing the symptom, 3=experiencing the symptom most of the time) yielding a total between 0 and 30. A score of 0-9 indicates little to no depressive symptoms and a score from 10-30 indicates significant depressive symptoms.
Monthly, after enrollment, up to 10 months
Change in Mood as assessed by The Young Mania Rating Scale
Time Frame: Monthly, after enrollment, up to 10 months
Clinical interview that measures manic symptoms in the past 2 weeks, each item is scored 0-4 (0=absent, 4=fully present) yielding a total between 0 and 44. Any score above 0 indicates a possible manic episode.
Monthly, after enrollment, up to 10 months
Side Effect as assessed by the Udvalg for Kliniske Undersøgelser Side Effects Rating Scale
Time Frame: Monthly, after enrollment, up to 10 months
Clinical interview that measures current, or in the past 72 hours, side effects of medication, each item is scored 0-3 (0=not or doubtfully present, 3=severe), yielding a total between 0 and 168. Any score above 0 indicates a possible causal relationship between medication and side effects.
Monthly, after enrollment, up to 10 months
Side Effect as assessed by the Frequency, Intensity, and Burden of Side Effects Rating Scale
Time Frame: Monthly, after enrollment, up to 10 months
Self-reported frequency, intensity, and burden of side effects in the past week, each item is scored 0-6 (0=no side effects/impairment, 6=present all the time/intolerable/unable to function) yielding a total between 0 and 18. For each item, a score of 0-2 indicates treatment should continue, a score of 3-4 indicates the side effect should be addressed, and a score of 5-6 indicates a change in treatment is needed.
Monthly, after enrollment, up to 10 months
Change in Infant Habituation as assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale
Time Frame: At 1, 2, 4, and 6 weeks postpartum
Neurobehavioral assessment measuring infant's ability to shut down response to a stimulus, the item is scored 1-9, a low score indicates no decrement in response over 10 stimuli and a high score indicates a shut down of response after 1-2 stimuli
At 1, 2, 4, and 6 weeks postpartum
Change in Infant Attention as assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale
Time Frame: At 1, 2, 4, and 6 weeks postpartum
Neurobehavioral assessment measuring infant's response to a stimulus, the item is scored 1-9, a low score indicates no response and a high score indicates alerting to stimulus
At 1, 2, 4, and 6 weeks postpartum
Change in Infant Self-Regulation as assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale
Time Frame: At 1, 2, 4, and 6 weeks postpartum
Neurobehavioral assessment measuring infant's ability to self-regulate, the item is scored 1-9, a low score indicates the infant makes no attempt to quiet self and a high score indicates the infant consistently quiets self for sustained periods
At 1, 2, 4, and 6 weeks postpartum
Change in Infant Arousal as assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale
Time Frame: At 1, 2, 4, and 6 weeks postpartum
Neurobehavioral assessment measuring infant's arousal, the item is scored 1-9, a low score indicates a low level of arousal to all stimuli and a high score indicates the infant achieves insulated crying
At 1, 2, 4, and 6 weeks postpartum
Change in Infant Tonicity as assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale
Time Frame: At 1, 2, 4, and 6 weeks postpartum
Neurobehavioral assessment measuring infant's body tone, the item is scored 1-9, a low score indicates the infant is flaccid and a high score indicates the infant is hypertonic
At 1, 2, 4, and 6 weeks postpartum
Change in Infant Reflexes as assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale
Time Frame: At 1, 2, 4, and 6 weeks postpartum
Neurobehavioral assessment measuring infant's reflexes, the item is scored 1-5, a low score indicates no response and a high score indicates a strong response
At 1, 2, 4, and 6 weeks postpartum
Change in Infant Quality of Movement as assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale
Time Frame: At 1, 2, 4, and 6 weeks postpartum
Neurobehavioral assessment measuring infant's power and flexibility, the item is scored 1-5, a low score indicates no resistance/movement and a high score indicates strong resistance/movement
At 1, 2, 4, and 6 weeks postpartum
Gestational Age at Birth in Weeks assessed by Review of the Infant Delivery Chart
Time Frame: At 2 weeks postpartum visit, up to 15 minutes
At 2 weeks postpartum visit, up to 15 minutes
Birth Length in Inches assessed by Review of the Infant Delivery Chart
Time Frame: At 2 weeks postpartum visit, up to 15 minutes
At 2 weeks postpartum visit, up to 15 minutes
Birth Weight in pounds assessed by Review of the Infant Delivery Chart
Time Frame: At 2 weeks postpartum visit, up to 15 minutes
At 2 weeks postpartum visit, up to 15 minutes
APGAR Score at 1 Minute assessed by Review of the Infant Delivery Chart
Time Frame: At 2 weeks postpartum visit, up to 15 minutes
At 2 weeks postpartum visit, up to 15 minutes
APGAR Score at 5 Minutes assessed by Review of the Infant Delivery Chart
Time Frame: At 2 weeks postpartum visit, up to 15 minutes
At 2 weeks postpartum visit, up to 15 minutes
Assessment of Neonatal Intensive Care Unit Admission by Review of the Infant Delivery Chart
Time Frame: At 2 weeks postpartum visit, up to 15 minutes
By reviewing the infant delivery chart, the outcome will be "yes" if the infant was admitted to the Neonatal Intensive Care Unit and "no" if the infant was not admitted
At 2 weeks postpartum visit, up to 15 minutes

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Johns Hopkins University

Investigators

  • Principal Investigator: Lindsay Standeven, MD, Johns Hopkins University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 3, 2018

Primary Completion (Estimated)

March 30, 2025

Study Completion (Estimated)

March 30, 2025

Study Registration Dates

First Submitted

December 11, 2018

First Submitted That Met QC Criteria

December 11, 2018

First Posted (Actual)

December 13, 2018

Study Record Updates

Last Update Posted (Actual)

March 12, 2024

Last Update Submitted That Met QC Criteria

March 8, 2024

Last Verified

March 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IRB00162134

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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