Epilepsy and pregnancy: effect of antiepileptic drugs and lifestyle on birthweight

Hvas, Christian Lodberg; Henriksen, Tine Brink; Østergaard, John R.; Dam, M.

doi:10.1111/j.1471-0528.2000.tb11089.x

Cited by 97 publications

(51 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In one Class II study, pregnancies to WWE taking AEDs had more than twice the risk of SGA outcomes (n ϭ 87) (OR 2.3, CI 1.3-4.0). 36 Pregnancies to WWE not taking AEDs did not show a significantly increased risk of SGA (OR 1.6, CI 0.9 -2.6). However, the study was insufficiently sensitive to exclude a substantially increased risk.…”

Section: Recommendationsmentioning

confidence: 99%

See 1 more Smart Citation

Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes [RETIRED]

Harden¹,

Meador²,

Pennell³

et al. 2009

Neurology

369

256

View full text Add to dashboard Cite

Objective: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy. Results: It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine and possible compared to phenytoin or lamotrigine. Compared to untreated WWE, it is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. It is probable that antiepileptic drug (AED) polytherapy as compared to monotherapy regimens contributes to the development of MCMs and to reduced cognitive outcomes. For monotherapy, intrauterine exposure to VPA probably reduces cognitive outcomes. Further, monotherapy exposure to phenytoin or phenobarbital possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of Ͻ7. Methods: Recommendations:If possible, avoidance of valproate (VPA) and antiepileptic drug (AED) polytherapy during the first trimester of pregnancy should be considered to decrease the risk of major congenital malformations (Level B). If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered to prevent reduced cognitive outcomes (Level B). If possible, avoidance of phenytoin and phenobarbital during pregnancy may be considered to prevent reduced cognitive outcomes (Level C). Pregnancy risk stratification should reflect that the offspring of women with epilepsy taking AEDs are probably at increased risk for being small for gestational age (Level B) and possibly at increased risk of 1-minute Apgar scores of Ͻ7 (Level C). Neurology ® 2009;73:133-141 GLOSSARY AAN ϭ Academy of Neurology; AED ϭ antiepileptic drug; CBZ ϭ carbamazepine; CI ϭ confidence interval; LTG ϭ lamotrigine; MCM ϭ major congenital malformation; OR ϭ odds ratio; PB ϭ phenobarbital; PHT ϭ phenytoin; RR ϭ relative risk; SGA ϭ small for gestational age; VPA ϭ valproate; WWE ϭ women with epilepsy.

show abstract

Section: Recommendationsmentioning

confidence: 99%

“…Two Class II studies 36,37 showed increased risk of SGA for offspring of WWE taking AEDs. In one Class II study, pregnancies to WWE taking AEDs had more than twice the risk of SGA outcomes (n ϭ 87) (OR 2.3, CI 1.3-4.0).…”

Section: Recommendationsmentioning

confidence: 99%

Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes [RETIRED]

Harden¹,

Meador²,

Pennell³

et al. 2009

Neurology

369

256

View full text Add to dashboard Cite

show abstract

“…15 The use of carbamazepine in pregnancy was significantly related to reduction in head circumference, lower birthweight and reduced length, [107][108][109] and similarly the use of valproate was associated with neonatal hypoglycaemia and reduced birth dimensions. 110,111 A study based on Swedish Medical Birth registry data from 1995 to 2001 identified a higher proportion of caesarean section (odds ratio 1.64, 95% CI 1.43 to 1.88), pre-eclampsia (odds ratio 1.66, 95% CI 1.32 to 2.08) among women exposed to anticonvulsant mood stabilisers than among women not exposed.…”

Section: Anticonvulsant Mood Stabilisersmentioning

confidence: 99%

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

View full text Add to dashboard Cite

BackgroundAlthough many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant.Objective(s)(1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy.DesignRetrospective cohort studies.SettingPrimary care.ParticipantsWomen treated for psychosis who became pregnant, and their children.InterventionsTreatment with antipsychotics, lithium or anticonvulsant mood stabilisers.Main outcome measuresDiscontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders.Data sourcesClinical Practice Research Datalink database and The Health Improvement Network primary care database.ResultsPrescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy.LimitationsA few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage.ConclusionsPsychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics.Future workFuture research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

show abstract

“…One Class II study 12 showed an increased risk for WWE who were smokers compared to control women who were also smokers (OR 3.4, 95% CI 1.8 -6.5) (data not given for all WWE compared to controls). One Class III study 13 also showed an increased risk (p Ͻ 0.05).…”

Section: Premature Contractions and Premature Labor And Deliverymentioning

confidence: 99%

Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Obstetrical complications and change in seizure frequency

Harden¹,

Hopp²,

Ting³

et al. 2009

Neurology

267

136

View full text Add to dashboard Cite

Objective: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including the risk of pregnancy complications or other medical problems during pregnancy in WWE compared to other women, change in seizure frequency, the risk of status epilepticus, and the rate of remaining seizure-free during pregnancy.Methods: A 20-member committee including general neurologists, epileptologists, and doctors in pharmacy evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and February 2008. Results: For WWE taking antiepileptic drugs, there is probably no substantially increased risk (greater than two times expected) of cesarean delivery or late pregnancy bleeding, and probably no moderately increased risk (greater than 1.5 times expected) of premature contractions or premature labor and delivery. There is possibly a substantially increased risk of premature contractions and premature labor and delivery during pregnancy for WWE who smoke. Seizure freedom for at least 9 months prior to pregnancy is probably associated with a high likelihood (84%-92%) of remaining seizure-free during pregnancy. Recommendations:Women with epilepsy (WWE) should be counseled that seizure freedom for at least 9 months prior to pregnancy is probably associated with a high rate (84%-92%) of remaining seizure-free during pregnancy (Level B). However, WWE who smoke should be counseled that they possibly have a substantially increased risk of premature contractions and premature labor and delivery during pregnancy (Level C). Neurology Recent estimates of the US population 1 and the prevalence of epilepsy 2 indicate that approximately one-half million women with epilepsy (WWE) are of childbearing age. It has also been estimated that three to five births per thousand will be to WWE.3 Epilepsy is defined by the presence of recurrent, unprovoked seizures, and the treatment is typically a daily, long-term antiepileptic drug (AED) regimen. The majority of people with epilepsy have well-controlled seizures, are otherwise healthy, and therefore expect to participate fully in life experiences, including childbearing.This parameter and the two companion parameters are updates of the previous practice parameter from 1998. The arbitrary cutoff date of 1985 was chosen because these relatively recent articles were thought to reflect current practice and AED usage patterns and therefore be more applicable and reliable for this assessment than earlier reports. The search terms used were seizures/epilepsy, catamenial epilepsy, pregnancy, anticonvulsants, antiepileptic drugs, teratogenesis, birth defects, pregnancy registry, cognitive outcome, vitamin K, folate/folic acid, breastfeeding, oral contraceptives, polycystic ovary syndrome, hormone replacement therapy, menopause, perimenopause, and fertility. The search was confined to articles using human subjects and included all languages for which there was an abstract in En...

show abstract

Epilepsy and pregnancy: effect of antiepileptic drugs and lifestyle on birthweight

Cited by 97 publications

References 28 publications

Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes [RETIRED]

Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes [RETIRED]

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Obstetrical complications and change in seizure frequency

Contact Info

Product

Resources

About