Contraception, pregnancy, and peripartum experiences among women with epilepsy in Bhutan

Halani, Sheliza; Tshering, Lhab; Bui, Esther; Clark, Sarah J.; Grundy, Sara J.; Pem, Tandin; Lhamo, Sonam; Dema, Ugyen; Nirola, Damber Kumar; Dorji, Chencho; Mateen, Farrah J.

doi:10.1016/j.eplepsyres.2017.10.012

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…Although the prescription of VPA to girls/women has decreased significantly in the past decade [6][7][8][9][10], older ASMs, including VPA, are still widely used, especially in low-and middle-income countries [11][12][13]. For this reason, we hope that new data obtained from our study with the highest number of simultaneously analyzed maternal serum, milk and infant serum concentrations (from one center using a consistent methodology) compared to all previous studies using varying and incomparable criteria [17,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

“…The prescription of VPA to girls/women in general and during pregnancy has decreased significantly in the past decade in many countries [6][7][8][9][10], but older ASMs, including VPA, are still widely used in low-and middle-income countries such as India, the Kingdom of Bhutan, and southern Caribbean countries. The higher cost of newer ASMs, such as lamotrigine and levetiracetam, their limited availability in the public distribution system, and the lack of familiarity with updated guidelines by care providers, are important barriers to their wider use [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Valproic Acid Concentrations in Mothers, Colostrum and Breastfed Infants during the Early Postpartum Period: Comparison with Concentrations Determined during Delivery and in the Mature Milk Period

2021

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To obtain information on the transport of valproic acid from mothers to colostrum and breastfed infants, in this cohort study, valproic acid concentrations in maternal serum (90 subjects), colostrum and the serum of breastfed infants were analyzed in years 1993–2018, between the 2nd and 5th postnatal days. Valproic acid concentrations ranged from 4.3 to 66.5 mg/L (mean 31.2 ± 13.6 mg/L) in maternal serum, from 0.5 to 5.9 mg/L (mean 1.1 ± 1.2 mg/L) in milk, and from 0.5 to 42.9 mg/L (mean 15.4 ± 9.4 mg/L) in infant serum. The milk/maternal serum concentration ratio ranged from 0.01 to 0.22 (mean 0.04 ± 0.04), and the infant/maternal serum concentration ratio ranged from 0.01 to 1.61 (mean 0.51 ± 0.28). A significant correlation was found between serum concentrations of breastfed infants and milk concentrations, maternal serum concentrations, maternal daily dose, and dose related to maternal body weight. Valproic acid concentrations in milk and infant serum did not reach the lower limit of the reference range used for the general epileptic population, and three-quarters of the concentrations in milk were lower than the lower limit of quantification. Routine monitoring of serum concentrations of breastfed infants is not necessary. If signs of potential adverse reactions are noted, serum concentrations of the infants should be measured.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Valproic Acid Concentrations in Mothers, Colostrum and Breastfed Infants during the Early Postpartum Period: Comparison with Concentrations Determined during Delivery and in the Mature Milk Period

2021

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“…After six months, approximately only one-third (33.1%) continued breastfeeding their children, and 12.8% were exclusively breastfed (Hao et al, 2017). In contrast, in the Bhutan kingdom, a majority of women (97%) reported breastfeeding in the questionnaire survey (Halani et al, 2017).…”

Section: The Current State Of Breastfeeding Of Newborns Of Mothers Wimentioning

confidence: 96%

A position paper on breastfeeding by women with epilepsy – working group report

Jędrzejczak

Wilińska

Kamińska

et al. 2020

Journal of Epileptology

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Introduction. On the initiative of the General Board of the Polish Society of Epileptology a Working Group was established to develop an expert position on breastfeeding by women with epilepsy in Poland. Aim. To facilitate a unified and rational approach to breastfeeding for women with epilepsy. methods. An ad hoc system was developed to classify available published evidence and expert opinions, which was used to evaluate recommendations on various aspects related to counselling, risk and safety of breastfeeding. Discussion and conclusions. This position paper provides an educational, practical and organizational aspects. It will allow for the introduction of a uniform protocol of conduct in Poland, which in turn will improve the safety of the mother and her child.

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“…80% received folic acid during pregnancy, although most started supplementation in the second trimester of pregnancy. 19 Another study reports that 65% of the women had had at least one unwanted pregnancy, 30.3% of them did not use a contraceptive method considered highly effective, correlated to lower income, younger age and less access to health insurance. 20 14.5% used hormonal contraception in combination with enzyme-inducing anti-epileptic drugs that could compromise contraceptive efficacy and 50% did not take folic acid before or during pregnancy.…”

Section: Anti-epileptic Drugs and Contraceptivesmentioning

confidence: 99%

Interactions Between Anti-Epileptic Drugs and Contraceptives: A Review

Sharma¹,

Sakshi²

2021

IHRJ

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Around half of the pregnancies in women with epilepsy are unplanned and the choice of contraceptive method in epileptic women is important, since it requires considering their possible pharmacological interactions with certain types of anti-epileptic drugs. Drugs from this class which induce hepatic enzyme activity may alter the metabolism of most hormonal methods of contraception, and this may affect their contraceptive efficacy. Hormonal contraception is regarded as highly effective, but its interaction with anti-epileptics may accelerate the metabolism of the latter with the consequent risk of failure, reduction of plasma concentration predisposing to seizures, risk of unwanted pregnancies, abortions, teratogenicity, maternal or fetal complications and difficulty in the management of epilepsy during pregnancy. In case of prescribing both medications, the combined use with a barrier method should be considered. Family planning counseling at the first visit has been shown to influence the choice of the contraceptive method. In conclusion, the different therapeutic options should be analyzed together with the epileptic patients in order to achieve and optimize the best goal for each one This article reviews these issues and offers practical recommendations for the management of contraception in epileptic patients.

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Contraception, pregnancy, and peripartum experiences among women with epilepsy in Bhutan

Cited by 6 publications

References 29 publications

Valproic Acid Concentrations in Mothers, Colostrum and Breastfed Infants during the Early Postpartum Period: Comparison with Concentrations Determined during Delivery and in the Mature Milk Period

Valproic Acid Concentrations in Mothers, Colostrum and Breastfed Infants during the Early Postpartum Period: Comparison with Concentrations Determined during Delivery and in the Mature Milk Period

A position paper on breastfeeding by women with epilepsy – working group report

Interactions Between Anti-Epileptic Drugs and Contraceptives: A Review

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