Do women with epilepsy benefit from epilepsy specific pre-conception care?

Baishya, Jitupam; Jose, Manna; Reshma, A; Sarma, P. Sankara; Thomas, Sanjeev V

doi:10.1016/j.eplepsyres.2019.106260

Cited by 11 publications

(3 citation statements)

References 7 publications

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“…For women with epilepsy who hope to conceive, many worry about how seizures, epilepsy treatment, and their developing fetus will impact one another. Preconception counseling, in addition to addressing women’s concerns, has been prospectively observed to lower antiseizure medication burden, improve folic acid use, and reduce seizure burden 40 . The value of preconception counseling is reinforced by its role in ensuring informed consent when choosing epilepsy therapies.…”

Section: Preconception Counselingmentioning

confidence: 99%

Women’s Issues in Epilepsy

Bui¹

2022

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: Issues pertaining to women with epilepsy have advanced with a better understanding of multidirectional influences among hormones, seizures, and antiseizure medications, as well as pregnancyrelated concerns around fertility, seizure destabilization, and antiseizure medication-associated teratogenicity. This article highlights important developments in this field and reviews best practices in the management of women with epilepsy.RECENT FINDINGS: Important external hormonal influences may impact women with epilepsy particularly in the context of gender-affirming medications, hormonal replacement therapy, and fertility therapies. Fertility for women with epilepsy is influenced by multiple variables; however, in the absence of preexisting fertility issues, epilepsy per se is not associated with significantly impaired fertility. Once women with epilepsy are pregnant, the majority have a stable course. Antiseizure medication use in pregnancy is associated with major congenital malformations 2 to 5 times that of the general population and is highest with high-dose (≥1500 mg or greater total daily) valproate. Carefully considered changes in drug choice and dose may mitigate these risks. Therapeutic drug monitoring plays an important role in pregnancy care, and under expert supervision, women with epilepsy in pregnancy have similar seizure risks as women with epilepsy who are not pregnant. As women with epilepsy age, bone health and menopause may further be impacted by seizures and antiseizure medications. SUMMARY: The care of women with epilepsy is a multifaceted discipline that recognizes the life-long impact of sex and gender influences on epilepsy care.

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Section: Preconception Counselingmentioning

confidence: 99%

Women’s Issues in Epilepsy

Bui¹

2022

CONTINUUM: Lifelong Learning in Neurology

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“…According to studies published in the past decade, preconceptional FA supplementation rates in women of childbearing age with epilepsy, including adolescent women, range between 9% and 52% (Hao et al, 2015; Herzog et al, 2017; Ishikawa et al, 2020; Minshall & Neligan, 2014; Moura et al, 2015; Passarelli et al, 2015; Petersen et al, 2019). Higher rates (82% and 88%) were reported with preconception care and following interventions that increased physician and patient awareness of the guidelines, adherence to pregnancy counseling during outpatient visits, and electronic reminders of FA prescription in women of childbearing age with epilepsy on AEDs (Baishya et al, 2020; Keni et al, 2020; Patel et al, 2018). Low FA supplementation rates were related to low rates of pregnancy counseling and FA prescription nonadherence, and were associated with specific clinical and demographic variables such as planned pregnancy, contraceptive method, education level, race, income, employment, and area of living (urban vs. rural in a developing country) (Herzog et al, 2017; Ishikawa et al, 2020; Minshall & Neligan, 2014; Moura et al, 2015; Passarelli et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Folic acid supplementation in women of childbearing age with epilepsy: No association with type or number of antiepileptic drugs

Gandelman‐Marton,

Theitler

2023

Birth Defects Research

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BackgroundFor over two decades, a daily folic acid (FA) supplementation has been recommended for women of childbearing age with epilepsy. This recommendation is based on evidence that FA administration before conception and during pregnancy can decrease the risk of fetal malformations in the general population, improve cognitive development, and reduce the risk of autistic traits in children exposed in utero to antiepileptic drugs (AEDs).ObjectiveThe aim of this study was to evaluate FA supplementation rate in nonpregnant women of childbearing age with epilepsy and its relation to AED type and number.MethodsWe retrospectively reviewed the computerized database and the medical records of all the women who had a first visit to our outpatient epilepsy clinic (Shamir‐Assaf Harofeh Medical Center, Zerifin, Israel) during a 10‐year period (2012–2021).ResultsOnly 61 (22%) of 282 nonpregnant women of childbearing age with epilepsy treated with AEDs received FA supplementation. Ninety‐two (33%) of the women were treated with AED polytherapy, and 41 (15%) received valproic acid in monotherapy or polytherapy. FA supplementation rate was higher in women aged ≤40 versus >40 (25% vs. 8.5%) (p = .004). No correlation was found between FA supplementation and AED type or number.ConclusionsFA supplementation rate was low and was unaffected by AED treatment. Patient and physician‐targeted interventions should be implemented to increase FA prescription and patient adherence.

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“…It is well established that most pregnancies in women with or without epilepsy are not planned. Preconceptional care has shown to improve seizure control during pregnancy and increase folic acid intake 12 ; however, it has not shown to decrease the risk for MFM, bringing back the argument that the rate of MFM in WWE is likely more related to the choice of ASM than the use of folic acid, in contrast to the general population. The possibility of folic acid improving long-term cognitive outcome in children born to WWE strengthens the case for the recommendation to take folic acid at a dose between 0.4 and 4 mg a day in the periconceptional period and throughout the pregnancy.…”

Section: Commentarymentioning

confidence: 99%