References

Agricola E, Gesualdo F, Pandolfi E, Gonfiantini MV, Carloni E, Mastroiacovo P, Tozzi AE Does googling for preconception care result in information consistent with international guidelines: a comparison of information found by Italian women of childbearing age and health professionals. BMC Medical Informatics and Decision Making. 2013; 13:(1) https://doi.org/10.1186/1472-6947-13-14

Baker GA, Bromley RL, Briggs M, Cheyne CP, Cohen MJ, García-Fiñana M, Gummery A, Kneen R, Loring DW, Mawer G, Meador KJ, Shallcross R, Clayton-Smith J IQ at 6 years after in utero exposure to antiepileptic drugs: a controlled cohort study. Neurol. 2015; 84:(4)382-90

Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, Engel J, French J, Glauser TA, Mathern GW, Moshé SL, Nordli D, Plouin P, Scheffer ZE Revised terminology and concepts for organisation of seizures and epilepsies: report of the ILAE commission on classification and terminology, 2005–2009. Epilepsia. 2010; 51:(4)676-85

Bjørk MH, Veiby G, Reiter SC, Berle JO, Daltveit AK, Spigset O, Engelsen BA, Gilhus NE Depression and anxiety in women with epilepsy during pregnancy and after delivery: a prospective population based cohort study on frequency, risk factors, medication, and prognosis. Epilepsia. 2016; 56:(1)28-39

Bromley R, Weston J, Adab N, Greenhalgh J, Sanniti A, McKay AJ, Tudur Smith C, Marson AG Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child. Cochrane Database Syst Rev Issue 10. Art. No.: CD010236. 2014; https://doi.org/10.1002/14651858.CD010236.pub2

Bromley RL, Calderbank R, Cheyne CP, Rooney C, Trayner P, Clayton-Smith J, García-Fiñana M, Irwin B, Morrow JI, Shallcross R, Baker GA Cognition in school-age children exposed to levetiracetam, topiramate, or sodium valproate. Neurol. 2016; 87:(18)1943-53 https://doi.org/10.1212/WNL.0000000000003157

Boukhris T, Sheehy O, Mottron L, Bérard A Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatr. 2015; 170:(2)117-24

Campbell E, Hunt S, Kinney MO, Guthrie E, Smithson WH, Parsons L, Irwin B, Morrison PJ, Morrow J, Craig J, Russell AJ The effect of socioeconomic status on treatment and pregnancy outcomes in women with epilepsy in Scotland. Epilepsy Behav. 2013; 28:(3)354-7

Campbell E, Kennedy F, Russell A, Smithson W-H, Parsons L, Morrison PJ, Liggan B, Irwin B, Delanty N, Hunt SJ, Craig J, Morrow J Malformation risks of antiepileptic drug monotherapies in pregnancy: updated results from the UK and Ireland Epilepsy and Pregnancy Registers. J Neurol Neurosurg Psychiatry. 2014; 14:(85)1029-34

Chentouf A Epilepsy and psychiatric disorders: is there a common genetic susceptibility?. J Epilepsy. 2016; 2:(2) https://doi.org/http://dx.doi.org/10.4172/2472-0895.1000e009

Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, Vestergaard M Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA. 2013; 309:(16)1696-703

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 Outcomes. 2016; 3:(2)131-43 https://doi.org/10.1007/s40801-016-0078-1

Dolk H, Wang H, Loane M, Morris J, Garne E, Addor M-C, Arriola L, Bakker M, Barisic I, Doray B, Gatt M, Kallen K, Khoshnood B, Klungsoyr K, Lahesmaa-Korpinen A-M, Latos-Bielenska A, Mejnartowicz JP, Nelen V, Neville A, O'Mahony M, Pierini A, Rißmann A, Tucker D, Wellesley D, Wiesel A, de Jong-van den Berg LTW Lamotrigine use in pregnancy and risk of orofacial cleft and other congenital anomalies. Neurology. 2016; 86:(18)1716-25

Edey S, Moran N, Nashef L SUDEP and epilepsy-related mortality in pregnancy. Epilepsia. 2014; 55:(7)e72-4

Fiest KM, Dykemann J, Patten SB, Wiebe S, Kaplan GG, Maxwell CJ, Bulloch AGM, Jette N Depression in epilepsy: a systematic review and meta-analysis. Neurology. 2013; 80:(6)590-9

Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J, Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshe SL, Perucca E, Scheffer IE, Tomson I, Watanabe M, Wiebe S ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014; 55:(4)475-82

Fisher RS Redefining epilepsy. Curr Opin Neurol. 2015; 28:(2)130-5

Grant CLondon: Jonathon Cape; 2016

Inoyama K, Meador KJ Cognitive outcomes of prenatal antiepileptic drug exposure. Epilepsy Res. 2015; 114:89-97

Leeds: JEC; 2011

London: BMJ/RPS; 2017

In: Knight M, Nair M, Tuffnell D, Kenyon S, Shakespeare J, Brocklehurst P, Kurinczuk JJ (Eds.). Oxford: National Perinatal Epidemiology Unit; 2016

Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol. 2013; 12:(3)244-52

Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 Years. JAMA Pediatr. 2014; 168:(8)729-36

Meador KJ, Lorring DW Developmental effects of antiepileptic drugs and the need for improved regulation. Neurology. 2016; 86:(3)297-306

Medicines and Healthcare products Regulatory Agency (MHRA) Sanofi. Important information for healthcare professionals on the risks of Valproate in female patients. 2016. http://www.medicines.org.uk/emc/RMM.420.pdf (Accessed 20 April 2017)

Morley K Antiepileptic drug management during pregnancy: a shared decision approach. British Journal of Midwifery. 2016a; 24:(5)353-61

Maternity epilepsy shared-care toolkit. 2016b. http://www.womenwithepilepsy.co.uk (accessed 11 April 2017)

Nair M, Knight M, Kurinczuk JJ Risk factors and newborn outcomes associated with maternal deaths in the UK from 2009 to 2013: a national case–control study. BJOG. 2016; 123:(10)1654-1662 https://doi.org/10.1111/1471-0528.13978

London: NICE; 2012

London: NICE; 2016a

London: NICE; 2016b

Patel SI, Pennell PB Management of epilepsy during pregnancy: an update. Ther Adv Neurol Disord. 2016; 9:(2)118-29

London: RCOG; 2016

Shahrook S, Hanada N, Sawada K, Ota E, Mori R Vitamin K supplementation during pregnancy for improving outcomes. Cochrane Database Sys Rev. 2014; https://doi.org/10.1002/14651858.CD010920

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

Tomson T, Klein P Fine-tuning risk assessment with antiepileptic drug use in pregnancy. Neurol. 2015; 84:(4)339-340

Winterbottom JB, Pulman J, Greenhalgh J, Smyth RMD, Marson AG Preconception counselling for women with epilepsy. Cochrane Database Syst Rev. 2014; https://doi.org/10.1002/14651858.CD011007

Wood AG, Nadebaum C, Anderson V, Reutens D, Barton S, O'Brien TJ, Vajda F Prospective assessment of autism traits in children exposed to antiepileptic drugs during pregnancy. Epilepsia. 2015; 56:(7)1047-55

Vajda FJE, O'Brien TJ, Lander CM, Graham J, Eadie MJ The teratogenicity of the newer antiepileptic drugs – an update. Acta Neurol Scand. 2014; 130:(4)234-8 https://doi.org/10.1111/ane.12280

Veiby G, Daltveit AK, Schjølberg S, Stoltenberg C, Øyen A-S, Vollset SE, Engelsen BA, Gilhus NE Exposure to antiepileptic drugs in utero and child development: a prospective population-based study. Epilepsia. 2013; 54:(8)1462-72

Veiby G, Daltveit AK, Engelsen BA, Gilhus NE Fetal growth restriction and birth defects with newer and older antiepileptic drugs during pregnancy. J Neurol. 2014; 261:(3)579-88

Zhao Y, Hebert MF, Venkataramanan R Basic obstetric pharmacology. Sem Perinatol. 2014; 38:(8)475-86

Caring for pregnant women with long-term conditions: maternal and neonatal effects of epilepsy

02 May 2017
13 min read
Volume 25 · Issue 5

Abstract

Epilepsy affects around 1 in 100 people and every year around 2500 women with epilepsy become pregnant. Although most will have an uneventful pregnancy, pregnancy for women with epilepsy carries additional risks to their wellbeing and that of their developing fetus and their infant. For some women, these risks include worsening symptoms of epilepsy, increased mortality risks and less effective treatment of other conditions and comorbidities like depression. For the developing fetus and infant, exposure to antiepileptic drugs can affect organogenesis and later development. This article highlights essential knowledge about this condition in pregnancy and considers how midwives can contribute to working collaboratively in ways that optimise pregnancy outcomes for these women.

Worldwide, epilepsy is thought to affect approximately 1% of people (Grant, 2016). Though subject to various methodological (definitions of disease) and clinical issues (diagnostic criteria) this statistic equates to around 600,000 people having the condition in the UK (Joint Epilepsy Council of the UK and Ireland (JEC), 2011). Current best estimates suggest that 23% (about 139,000) of people diagnosed with the condition and receiving anti-epileptic drugs (AEDs) are women of reproductive age (12–50 years old) (JEC, 2011). This statistic equates to around 2500 pregnancies per year across the UK for women with epilepsy (WWE) (JEC, 2011). Of particular concern for WWE and health professionals are the risks posed to infant health due to tonic-clonic epileptic seizures and the effects of AED regimes (Veiby et al, 2013; Bromley et al, 2014). This article explores maternal and neonatal effects of epilepsy, its management and the use of AEDs for this condition and others for positive pregnancy outcomes. Having a greater understanding of this topic will help midwives appreciate the need for multi-professional and multi-agency working and why the provision of specialist advice and support is important.

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