epilepsy during pregnancy
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Epidemiology
Laboratory
- anticonvulsant monitoring
Complications
- 20% of women with epilepsy experience an increased frequency of seizures during pregnancy
- fetal anomalies
- fetal anticonvulsant syndrome
- fetal cardiovascular malformation
- higher rates of major congenital malformations in children of women taking multiple antieleptic drugs vs those taking a single agent (9.1% vs 6.2%)*
- antenatal hypertension (not preeclampsia)
- modestly increased risk of obstetrical complications (induced labor)
* corresponding rate for non-epileptics reported as 4.5% seems high
Management
- administer anticonvulsants only to patients with well- documented epilepsy
- monotherapy at the lowest possible dose should be used
- risk of congenital malformation is dose-dependent[4]
- the medication dose is likely to increase during pregnancy
- levetiracetam & lamotrigine are the preferred anticonvulsants[1]
- levetiracetam does not seem to effect language or developmental scores[6]
- phenytoin & valproic acid are pregnany category D
- increased risk of neural tube defects
- topiramate, carbamazepine, & multiple anticonvulsant associated with congenital malformations[1]
- administration of folate decreases the risk of neural tube defects in the fetus
- vitamin K should be administered to avoid neonatal bleeding before & during delivery
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18 American College of Physicians, Philadelphia 1998, 2012, 2018
- ↑ Journal Watch 24(8):67, 2004 Richmond JR et al Am J Obstet Gynecol 190:371 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14981376
- ↑ Prescriber's Letter 17(1): 2010 Antiepileptics in Pregnancy COMMENTARY: Antiepileptics in Pregnancy GUIDELINES: Managing Epilepsy During Pregnancy Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260107&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 Tomson T et al Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry The Lancet Neurology, Early Online Publication, 6 June 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21652013 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(11)70107-7/abstract
- ↑ Harden CL, Meador KJ, Pennell PB et al Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009 Jul 14;73(2):133-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19398681
- ↑ 6.0 6.1 Shallcross R et al In utero exposure to levetiracetam vs valproate. Development and language at 3 years of age. Neurology. Jan 8, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24401687 <Internet> http://www.neurology.org/content/early/2014/01/08/WNL.0000000000000030.short
Klein P, Mathews GC Antiepileptic drugs and neurocognitive development. Neurology. Jan 8, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24401684 <Internet> http://www.neurology.org/content/early/2014/01/08/WNL.0000000000000044.extract - ↑ Meador KJ, Baker GA, Browning N et al Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol. 2013 Mar;12(3):244-52 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23352199