Pregnancy Can Be Safe for Women with Epilepsy
Cynthia Harden, M.D., of the University of Miami, and colleagues have published updated guidelines for use of anti-epileptic drugs in women who wish to get pregnant and those who are in their pregnancy. The guidelines, based on a systematic review of evidence on managing women of child-bearing age who have epilepsy, have been published in Neurology and Epilepsia. The 20-member committee evaluated relevant articles published between 1985 and October 2007.
Some of the key guideline recommendations for managing epilepsy during pregnancy include:
- Blood levels of seizure medications should be checked regularly because pregnancy tends to depress them.
- Phenytoin and phenobarbital should be used with caution because they can impair cognitive development in children.
- Smoking substantially increases the risk of premature contractions, labor, and delivery in women with epilepsy.
- There is little evidence to support or refute vitamin K supplements during pregnancy to reduce risk of perinatal hemorrhage.
- The panel advises avoidance of valproate as evidence from numerous studies link the drug to major congenital abnormalities. These abnormalities include neural tube defects, facial clefts, and hypospadias.
- The panel recommends use of as few (only one if possible) anticonvulsants as possible. There is increased cognitive impairment in children when mothers take multiple anticonvulsants during pregnancy.
Women who have epilepsy and are considering pregnancy should be consider not doing so until they have been seizure-free for at least nine months prior to conception. This will give them an 84-92% chance of remaining seizure free during pregnancy.
Their risk of pregnancy-related complications are not substantially increased. While many common seizure drugs cross the placenta, and may show up in breast milk at low levels, there is no evidence of harm to the newborns with the exception of valproate and, to a lesser extent, phenobarbital and phenytoin. If valproate can be avoided, then there will be minimal adverse outcomes in their children.
As important as folic acid supplementation is in all pregnant women, it is even more so in women taking anti-seizure medications. It is recommended that before conception, the woman begin taking folic acid supplementation (at least 0.4 mg/day).
By working with her physicians, a woman with epilepsy can become pregnant and have a happy outcome.
Practice parameter update: management issues for women with epilepsy-focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding; Neurology 2009; DOI: 10.1212/WNL.0b013e3181a6b325; Harden C, et al
Practice parameter update: management issues for women with epilepsy-focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes; Neurology 2009; DOI: 10.1212/WNL.0b013e3181a6b312.; Harden C, et al
Harden C, et al., "Practice parameter update: management issues for women with epilepsy-focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency" Neurology 2009; DOI: 10.1212/WNL.0b013e3181a6b2f8.