Epilepsy in pregnancy

Tomson, Torbjörn; Hiilesmaa, Vilho

doi:10.1136/bmj.39266.473113.be

Cited by 68 publications

(31 citation statements)

References 47 publications

(33 reference statements)

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“…The fetal complications of maternal epilepsy range from malformation to milder ones, but increase childhood mortality and morbidity, including low birth weight (LBW), being small for gestational age (SGA) and preterm delivery [7,8]. Major malformation was documented as being linked to AED exposure (especially polypharmacy and valproate) and may be dose related [4,[9][10][11]. However, the rate of LBW, SGA and preterm delivery among epileptic women is debated.…”

Section: Introductionmentioning

confidence: 98%

No increase in adverse pregnancy outcomes for women receiving antiepileptic drugs

et al. 2009

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The objectives of this study were (1) to investigate the incidence of adverse pregnancy outcomes among the epileptic and general populations, including small for gestational age (SGA), low birth weight (LBW) and preterm delivery, using two large-scale nationwide population-based databases, and (2) to compare the risk of these adverse pregnancy outcomes between epileptic women who did and who did not receive antiepileptic drug (AED) treatment during pregnancy. This study used two national datasets: the National Health Insurance Research Dataset and birth certificate registry. We identified a total of 1,182 women who gave birth from 2001 to 2003 in Taiwan who had been diagnosed with epilepsy within the 2 years preceding the index delivery, together with 5,910 matched women as a comparison cohort. Multivariate logistic regression analyses were performed for estimation of risk. We found that approximately 14% of women with epilepsy received AED treatment during gestation. The adjusted odds of LBW, preterm births and SGA for epileptic women not receiving AED treatment during pregnancy were 1.31 (95% CI, 1.02-1.68), 1.35 (95% CI, 1.07-1.71) and 1.23 (95% CI, 1.03-1.46) times that of women without epilepsy, respectively. In contrast, no significant difference in the risk of LBW infants, preterm births and SGA babies was observed between epileptic mothers receiving AED treatment during pregnancy and women without epilepsy. Our study documents an increased risk of adverse pregnancy outcomes for epileptic women who do not receive AED treatment during pregnancy, but none for epileptic women who do receive treatment.

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Section: Introductionmentioning

confidence: 98%

No increase in adverse pregnancy outcomes for women receiving antiepileptic drugs

et al. 2009

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“…In a review of all maternal deaths in the UK from 1985 to 1999, women with epilepsy accounted for 3.8% of the mortality [1]. This is much more than expected considering that the prevalence of epilepsy in pregnancy has been estimated at 0.3-0.4% [45]. The mortality was partly related to seizure occurrence after abrupt withdrawal of AED treatment.…”

Section: Introductionmentioning

confidence: 97%

“…It has been estimated that 0.3-0.4% of all children today are born to mothers with epilepsy [45]. The vast majority of these women will have uneventful pregnancies and give birth to perfectly normal children.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy and epilepsy: what should we tell our patients?

Tomson

Battino

2009

J Neurol

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Women with epilepsy that plan to become pregnant can in general look forward to uneventful pregnancies and to giving birth to normal children. However, there are certain risks associated with epilepsy and antiepileptic drug (AED) treatment, and it is likely that these risks can be reduced with appropriate prepregnancy counseling. Women with epilepsy should be informed that maintained control of tonic-clonic seizures is important for their health as well as for the well-being of the fetus; that pregnancy in general has little effect on seizure control; but that pregnancy may affect plasma concentrations of AEDs, and that drug level monitoring and dosage adjustments may be needed. They should be informed of the moderately increased risk of birth defects, and that this risk appears to be higher with the use of valproate, in particular at doses above 800 mg/day. The possibility of changing from valproate to another AED should be considered, but such changes should be tried out before conception. Withdrawing or changing an AED should generally be avoided during pregnancy. Women with epilepsy on AED treatment should be encouraged to breast-feed.

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“…Selection should be made the most appropriate for patient. Changing during pregnancy is rarely justified, risk probably overweight potential gain (Tomson & Hiilesmaa, 2007). To ascertain whether epilepsy remains in remission enough time before conception is required.…”

Section: Optimization Of Treatmentmentioning

confidence: 99%