Pregnancy in Women with Epilepsy

Laskowska, Marzena; Leszczyńska‐Gorzelak, Bożena; Oleszczuk, Jan

doi:10.1159/000052902

Cited by 27 publications

(16 citation statements)

References 13 publications

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“…One Class III study 13 also showed an increased risk (p Ͻ 0.05). Another Class III study 8 demonstrated no significant increased risk but was insufficiently sensitive to exclude a substantially increased risk (OR 8.24, 95% CI 0.92-70.32). A Class III study 11 showed no significant increased risk but was not sufficiently sensitive to exclude an increased risk (RR 0.7, 95% CI 0.3-1.4).…”

Section: Premature Contractions and Premature Labor And Deliverymentioning

confidence: 97%

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

270

136

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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...

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Section: Premature Contractions and Premature Labor And Deliverymentioning

confidence: 97%

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

270

136

View full text Add to dashboard Cite

show abstract

“…One Class III study (Wilhelm et al, 1990) also showed an increased risk (p < 0.05). Another Class III study (Laskowska et al, 2001) demonstrated no significant increased risk but was insufficiently sensitive to exclude a substantially increased risk (OR 8.24,. A Class III study (Hiilesmaa et al, 1985) showed no significant increased risk but was not sufficiently sensitive to exclude an increased risk (RR 0.7, 95% CI 0.3-1.4).…”

Section: Premature Contractions and Premature Labor And Deliverymentioning

confidence: 99%

“…Three Class III studies [OR 17.88,.58 (Laskowska et al, 2001); OR 1.58, 95% CI 1.10-2.25 (Olafsson et al, 1998); and OR 2.2, 95% CI 1.42-3.41 (Sawhney et al, 1996) ] demonstrated a significant substantial increased risk.…”

Section: Cesarean Deliverymentioning

confidence: 99%

Management issues for women with epilepsy—Focus on pregnancy (an evidence‐based review): I. Obstetrical complications and change in seizure frequency

et al. 2009

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SUMMARYA committee assembled by the American Academy of Neurology (AAN) reassessed the evidence related to the care of women with epilepsy (WWE) during pregnancy, including the risk of pregnancy complications or other medical problems during pregnancy, change in seizure frequency, the risk of status epilepticus, and the rate of remaining seizure-free during pregnancy. The committee evaluated the available evidence according to a structured literature review and classification of relevant articles. For WWE who are taking antiepileptic drugs (AEDs), there is probably no substantially increased risk (>2 times expected) of cesarean delivery or late pregnancy bleeding, and probably no moderately increased risk (>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. WWE should be counseled that 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. WWE who smoke should be counseled that they possibly have a substantially increased risk of premature contractions and premature labor and delivery. KEY WORDS: Guideline, Pregnancy, Epilepsy, Seizure, Complications. This article is being published jointly/simultaneously by ILAE in Epilepsia and AAN in Neurology. Recent estimates of the U.S. population (United StatesDepartmentWiley Periodicals, Inc. ª 2009 International League Against Epilepsy Epilepsia, 50(5): 1229-1236, 2009 doi: 10.1111/j.1528-1167.2009.02128.x SPECIAL REPORT1229 approximately one-half million women with epilepsy (WWE) are of childbearing age. It has also been estimated that 3-5 births per thousand will be to WWE (Yerby, 2000). 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 child-bearing.This parameter and the two companion parameters are updates of the previous practice parameter from 1998 (American Academy of Neurology, 1998). They employ improved methodology for the development of practice parameters to analyze a large number of new studies informing the clinical management of WWE who are pregnant or plan pregnancy.This parameter summarizes evidence for two broad clinical questions:Compared to women without epilepsy, are WWE at increased risk for pregnancy-related complications, including (1) cesarean delivery; (2) preeclampsia; (3) pregnancy-induced hypertension; (4) premature contractions or premature labor and delivery; (5) bleeding complications; and (6) spontaneous abortion?For WWE who become pregnant, what is the risk of epilepsy-related complications during pregnancy, including (1) change in seizure frequency, (2) risk of status epilepticus, and (3) chance...

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“…Most of the females with epilepsy have uneventful pregnancies [2,3] but many studies have shown that epilepsy can cause increased complications in the form of abortions, bleeding in early pregnancy, nausea and vomiting, preterm labor, hypertension, intrauterine growth restriction, intrauterine foetal demise and increased caesarean delivery rates [4][5][6]. The fetus is at a much higher risk of teratogenicity due to the antiepileptic drug (AED) intake by the mother [7].…”

Section: Introductionmentioning

confidence: 99%

Maternal and Fetal Outcomes of Women with Epilepsy: Study from a Tertiary Care Center in India

Chawla¹

2015

OGIJ

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Pregnancy in Women with Epilepsy

Cited by 27 publications

References 13 publications

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

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

Management issues for women with epilepsy—Focus on pregnancy (an evidence‐based review): I. Obstetrical complications and change in seizure frequency

Maternal and Fetal Outcomes of Women with Epilepsy: Study from a Tertiary Care Center in India

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