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Management of women with epilepsy: from preconception to post-partum

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Abstract

Purpose

The physiological changes during pregnancy can significantly alter antiepileptic drug (AED)’s absorption, distribution, metabolism and elimination, thus influencing their plasma concentration. Considering that the risks of using old and new AEDs during pregnancy are still debated, our aim is to review the available evidence on this topic.

Methods

Narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases.

Results

The old AEDs generation (benzodiazepines, phenytoin, carbamazepine, phenobarbital and valproic acid) is teratogenic: minor congenital malformations, such as facial dysmorphism and other anomalies, occur in 6–20 % of infants exposed to AEDs in utero; this value is two times greater than the value reported in the general population. Major congenital malformations (MCM) such as cleft lip and cleft palate, heart defects (atrial septal defect, Fallot’s tetralogy, ventricular septal defect, aortic coarctation, patent ductus arteriosus, and pulmonary stenosis) and urogenital anomalies were estimated to be 4–6 % of infants born from mothers treated with AEDs, compared to 2–3 % of the general population.

Conclusion

It is essential to inform women treated with AED that planning pregnancy is necessary, when possible. The problems related to antiepileptic therapy and the possibilities of prenatal diagnosis should be accurately discussed with the patient, when possible before pregnancy: individual circumstances, desire to have children, severity of epilepsy, risks of seizures, family history of congenital malformations and all other potential risk factors must be considered, involving the patient in shared clinical decision-making.

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Authors and Affiliations

  1. Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Via C. Valeria 1, 98125, Messina, Italy

    Antonio Simone Laganà, Onofrio Triolo & Valeria D’Amico

  2. Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via C. Valeria 1, 98125, Messina, Italy

    Sandy Maria Cartella, Vincenza Sofo & Francesca Maria Salmeri

  3. Department of Reproduction, University Medical Center Ljubljana, Slajmerjeva 3, 1000, Ljubljana, Slovenia

    Eda Vrtačnik Bokal

  4. Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria 1, 98125, Messina, Italy

    Edoardo Spina

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  1. Antonio Simone Laganà
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  2. Onofrio Triolo
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Correspondence to Antonio Simone Laganà.

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Laganà, A.S., Triolo, O., D’Amico, V. et al. Management of women with epilepsy: from preconception to post-partum. Arch Gynecol Obstet 293, 493–503 (2016). https://doi.org/10.1007/s00404-015-3968-7

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  • DOI: https://doi.org/10.1007/s00404-015-3968-7

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