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Epilepsy and Pregnancy

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Abstract

Managing epilepsy in pregnancy poses a unique challenge for the clinician given the need to balance seizure control with the potential teratogenic effects of antiepileptic drugs (AEDs) on the developing fetus. It has been estimated that 0.3–0.5% of all pregnancies occur in women with epilepsy (WWE) (Levy and Yerby. Epilepsia. 1985; 26(s1):S52–7). Given that a large portion of pregnancies are unplanned, careful consideration of AEDs with low risk to the fetus should be made in every WWE of childbearing age before they conceive. Once pregnant, monitoring of AEDs is important because metabolic and hormonal changes affect AED levels. After the child is born, women should be encouraged to breastfeed, even if taking AEDs, given that the benefits of breastfeeding and the evidence that no detrimental effects occur in studies directly assessing child outcomes.

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References

  1. Thomas SV, Syam U, Devi JS. Predictors of seizures during pregnancy in women with epilepsy. Epilepsia. 2012;53(5):2010–3.

    Article  Google Scholar 

  2. Harden CL, Hopp J, Ting TY, Pennell PB, Jacqueline A, Hauser WA, et al. Management issues for women with epilepsy – focus on pregnancy (an evidence-based review): I. Obstetrical complications and change in seizure frequency neurology and the American Epilepsy. Society. 2009;50(5):1229–36.

    Google Scholar 

  3. Chen Y-H, Chiou H-Y, Lin H-C, Lin H-L. Affect of seizures during gestation on pregnancy outcomes in women with epilepsy. Arch Neurol. 2009;66(8):979–84.

    Article  Google Scholar 

  4. Rauchenzauner M, Ehrensberger M, Prieschl M, Kapelari K, Bergmann M, Walser G, Neururer S, Unterberger I, Luef G. Generalized tonic–clonic seizures and antiepileptic drugs during pregnancy—a matter of importance for the baby? J Neurol. 2013;260(2):484–8.

    Article  CAS  Google Scholar 

  5. Battino D, Tomson T, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia. 2013;54(9):1621–7.

    Article  CAS  Google Scholar 

  6. Herzog AG, Mandle HB, Cahill KE, Fowler KM, Hauser WA. Predictors of unintended pregnancy in women with epilepsy. Neurology. 2017;88:1–7.

    Article  Google Scholar 

  7. Bhakta J, Bainbridge J, Borgelt L. Teratogenic medications and concurrent contraceptive use in women of childbearing ability with epilepsy. Epilepsy Behav [Internet]. 2015 [cited 2017 Sep 6];52:212–217. Available from: http://linkinghub.elsevier.com/retrieve/pii/S152550501500462X.

  8. Gerard EE, Meador KJ. Managing epilepsy in women. Continuum (Minneap Minn). 2016;22:204–26.

    Google Scholar 

  9. Harden CL, Meador KJ, Pennell PB, Hauser WA, Gronseth GS, French JA, et al. Practice parameter update: management issues for women with epilepsy – focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes. Neurology [Internet]. 2009;73(2):133–41.. Available from: http://www.neurology.org/content/73/2/133.abstract

    Article  CAS  Google Scholar 

  10. Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Perucca E, et al. Dose-dependent teratogenicity of valproate in mono- and polytherapy: an observational study. Neurology. 2015;85(10):866–72.

    Article  CAS  Google Scholar 

  11. Hernandez S, Shen A, Holmes LB. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012;78:1692–9.

    Article  Google Scholar 

  12. Janneke J, Loane M, Dolk H, Barisic I, Ester G, Garne E, Morris JK, de Jong-van den Berg L. Valproic acid monotherapy in pregnancy and major congenital malformations. N Engl J Med [Internet]. 2010;362(23):2185–93. https://doi.org/10.1056/NEJMoa0907328.

    Article  Google Scholar 

  13. Campbell E, Kennedy F, Russell A, Smithson WH, Parsons L, Morrison PJ, et al. Malformation risks of antiepileptic drug monotherapies in pregnancy: updated results from the UK and Ireland Epilepsy and Pregnancy Registers. J Neurol Neurosurg Psychiatry [Internet]. 2014;85(9):1029 LP–1034.. Available from: http://jnnp.bmj.com/content/85/9/1029.abstract

    Article  Google Scholar 

  14. Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol [Internet]. 2011;10(7):609–17. https://doi.org/10.1016/S1474-4422(11)70107-7.

    Article  CAS  Google Scholar 

  15. Veroniki AA, Rios P, Cogo E, Straus SE, Finkelstein Y, Kealey R, et al. Comparative safety of antiepileptic drugs for neurological development in children exposed during pregnancy and breast feeding: a systematic review and network meta-analysis. BMJ Open [Internet]. 2017;7(7):e017248. https://doi.org/10.1136/bmjopen-2017-017248.

    Article  Google Scholar 

  16. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol [Internet]. 2013;12(3):244–52. https://doi.org/10.1016/S1474-4422(12)70323-X.

    Article  CAS  Google Scholar 

  17. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. Effects of fetal antiepileptic drug exposure: outcomes at age 4.5 years. Neurology. 2012;78(16):1207–14.

    Article  CAS  Google Scholar 

  18. Baker GA, Bromley RL, Briggs M, Cheyne CP, Cohen MJ, García-Fiñana M, et al. IQ at 6 years after in utero exposure to antiepileptic drugs: a controlled cohort study. Neurology. 2015;84(4):382–90.

    Article  CAS  Google Scholar 

  19. Nadebaum C, Anderson V, Vajda F, Reutens D, Barton S, Wood A. Language skills of school-aged children prenatally exposed to antiepileptic drugs. Neurology. 2011;76(8):719–26.

    Article  CAS  Google Scholar 

  20. Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA [Internet]. 2013;309(16):1696. https://doi.org/10.1001/jama.2013.2270.

    Article  CAS  Google Scholar 

  21. Veroniki AA, Cogo E, Rios P, Straus SE, Finkelstein Y, Kealey R, et al. Comparative safety of anti-epileptic drugs during pregnancy: a systematic review and network meta-analysis of congenital malformations and prenatal outcomes. BMC Med [Internet]. 2017;15(1):95. https://doi.org/10.1186/s12916-017-0845-1.

    Article  CAS  Google Scholar 

  22. de Jong J, Garne E, de Jong-Van den Berg LTW, Wang H. The risk of specific congenital anomalies in relation to newer antiepileptic drugs: a literature review. Drugs Real World Outcome [Internet]. 2016;3(2):131–43.. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4914544/

    Article  Google Scholar 

  23. Werler MM, Ahrens KA, Bosco JLF, Mitchell AA, Anderka MT, Gilboa SM, et al. Use of antiepileptic medications in pregnancy in relation to risks of birth defects. Ann Epidemiol [Internet]. 2017;21(11):842–50. https://doi.org/10.1016/j.annepidem.2011.08.002.

    Article  Google Scholar 

  24. Meador K, Reynolds MW, Crean S, Fahrbach K, Probst C. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res [Internet]. 2008;81(1):1–13.. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660205/

    Article  Google Scholar 

  25. Tomson T, Battino D. Teratogenic effects of antiepileptic drugs. Lancet Neurol. 2012;11(9):803–13.

    Article  CAS  Google Scholar 

  26. Bromley RL, Calderbank R, Cheyne CP, Rooney C, Trayner P, Clayton-Smith J, et al. Cognition in school-age children exposed to levetiracetam, topiramate, or sodium valproate. Neurology. 2016;87(18):1943–53.

    Article  CAS  Google Scholar 

  27. Harden CL, Pennell PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, et al. Management issues for women with epilepsy-focus on pregnancy (an evidence-based review): III. Vitamin K, folic acid, blood levels, and breast-feeding. Epilepsia [Internet]. 2009;50(5):1247–55. https://doi.org/10.1111/j.1528-1167.2009.02130.x.

    Article  Google Scholar 

  28. Holmes LB, Mittendorf R, Shen A, Smith CR, Hernandez-Diaz S. Fetal effects of anticonvulsant polytherapies: different risks from different drug combinations. Arch Neurol [Internet]. 2011;68(10):1275–81. https://doi.org/10.1001/archneurol.2011.133.

    Article  Google Scholar 

  29. Weston J, Bromley R, Jackson CF, Adab N, Clayton-Smith J, Greenhalgh J, et al. Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child. In: Bromley R, editor. Cochrane Database of Systematic Reviews [Internet]. Chichester: Wiley; 2016. https://doi.org/10.1002/14651858.CD010224.pub2.

    Chapter  Google Scholar 

  30. Winterfeld U. Pregnancy outcome following maternal exposure to pregabalin may call for concern. Neurology. 2016;86(24):2251–7.

    Article  CAS  Google Scholar 

  31. Patorno E, Bateman BT, Huybrechts KF, Macdonald SC, Cohen JM, Panchaud A, et al. Pregabalin use early in pregnancy and the risk of major congenital malformations. 2017;88(21):2020–5.

    Google Scholar 

  32. Pittschieler S, Brezinka C, Jahn B, Trinka E, Unterberger I, Dobesberger J, et al. Spontaneous abortion and the prophylactic effect of folic acid supplementation in epileptic women undergoing antiepileptic therapy. J Neurol [Internet]. 2008;255(12):1926–31. https://doi.org/10.1007/s00415-008-0029-1.

    Article  CAS  Google Scholar 

  33. Morrow JI, Hunt SJ, Russell AJ, Smithson WH, Parsons L, Robertson I, et al. Folic acid use and major congenital malformations in offspring of women with epilepsy: a prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry [Internet]. 2009;80(5):506 LP–511.. Available from: http://jnnp.bmj.com/content/80/5/506.abstract

    Article  Google Scholar 

  34. Jentink J, Bakker MK, Nijenhuis CM, Wilffert B, de Jong-van den Berg LTW. Does folic acid use decrease the risk for spina bifida after in utero exposure to valproic acid? Pharmacoepidemiol Drug Saf [Internet]. 2010. [cited 2017 Oct 27];19(8):803–7. https://doi.org/10.1002/pds.1975.

    Article  CAS  Google Scholar 

  35. Polepally AR, Pennell PB, Brundage RC, Stowe ZN, Newport DJ, Viguera AC, et al. Model-based lamotrigine clearance changes during pregnancy: clinical implication. Ann Clin Transl Neurol. 2014;1(2):99–106.

    Article  CAS  Google Scholar 

  36. Vajda FJE, O’Brien T, Lander C, Graham J, Eadie M. The efficacy of the newer antiepileptic drugs in controlling seizures in pregnancy. Epilepsia. 2014;55(8):1229–34.

    Article  CAS  Google Scholar 

  37. Reisinger TL, Newman M, Loring DW, Pennell PB, Meador KJ. Antiepileptic drug clearance and seizure frequency during pregnancy in women with epilepsy. Epilepsy Behav [Internet]. 2013;29(1):13–8.. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775962/

    Article  CAS  Google Scholar 

  38. Breastfeeding and the use of human milk. Pediatrics [Internet]. 2012;129(3):e827 LP–e841. Available from: http://pediatrics.aappublications.org/content/129/3/e827.abstract.

  39. Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M, et al. Effects of breastfeeding in children of women taking antiepileptic drugs. Neurology. 2010;75(22):1954–60.

    Article  CAS  Google Scholar 

  40. Veiby G, Engelsen BA, Gilhus NE. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding. JAMA Neurol [Internet]. 2013;70(11):1367. Available from: https://doi.org/10.1001/jamaneurol.2013.4290.

  41. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. Breastfeeding in children of women taking antiepileptic drugs. JAMA Pediatr [Internet]. 2014;168(8):729. https://doi.org/10.1001/jamapediatrics.2014.118.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. California Pacific Medical Center, California Pacific Neurosciences Institute, San Francisco, CA, USA

    Mariel Velez

  2. Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA

    Kimford J. Meador

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  1. Mariel Velez
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  2. Kimford J. Meador
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Editors and Affiliations

  1. Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA

    Mary Angela O’Neal

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Velez, M., Meador, K.J. (2019). Epilepsy and Pregnancy. In: O’Neal, M. (eds) Neurology and Psychiatry of Women. Springer, Cham. https://doi.org/10.1007/978-3-030-04245-5_14

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  • DOI: https://doi.org/10.1007/978-3-030-04245-5_14

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  • Publisher Name: Springer, Cham

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