Al-Aqeel S, Gershuni O, Al-Sabhan J, Hiligsmann M. Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy. Cochrane Database Syst Rev. 2017; 2

Asadi-Pooya A. High dose folic acid supplementation in women with epilepsy: Are we sure it is safe?. Seizure. 2015; 27:51-3

Bhatia M, Adcock JE, Mackillop L. The management of pregnant women with epilepsy: a multidisciplinary collaborative approach to care. Obstet Gynaecol. 2017; 19:(4)279-88

Borgelt L, Hart F, Bainbridge J. Epilepsy during pregnancy: focus on management strategies. Int J Womens Health. 2016; 8:505-17

Bromley R. The treatment of epilepsy in pregnancy: the neurodevelopmental risks associated with exposure to antiepileptic drugs. Reprod Toxicol. 2016; 64:(64)203-10

Bromley R, Weston J, Marson A. Maternal use of antiepileptic agents during pregnancy and major congenital malformations in children. JAMA. 2017; 318:(17)1700-01

Dixon PA, Kirkham JJ, Marson AG, Pearson MG. National Audit of Seizure management in Hospitals (NASH): results of the national audit of adult epilepsy in the UK. BMJ Open. 2015; 5:(3)

Driver and Vehicle Licensing Agency. Neurological Disorders. Assessing fitness to drive: Advice for medical professionals to follow when assessing drivers with neurological disorders. 2018. (accessed 11 March 2018)

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

Epilepsy Action. Tips for looking after a baby or young child when you have epilepsy. 2016. (accessed 30 July 2018)

Epilepsy Action. Taking epilepsy medicine. 2017. (accessed 30 July 2018)

Farmen AH, Grundt JH, Tomson T, Nakken KO, Nakling J, Mowinchel P, Øie M, Lossius ML. Age-specific birth rates in women with epilepsy: a population-based study. Brain Behav. 2016; 6:(8)

Fisher R, Acevedo C, Arzimanoglou A ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia. 2014; 55:(4)475-82

Güveli B, Atakl D, Rosti R Teratogenicity of antiepileptic drugs. Clinical Psychopharmacology And Neuroscience. Clin Psychopharmacol Neurosci. 2017; 15:(1)19-27

Herzog AG, Mandle HB, Cahill KE, Fowler KM, Hauser WA. Predictors of unintended pregnancy in women with epilepsy. Neurology. 2017; 88:(8)728-33

Hugill K, Meredith D. Caring for pregnant women with long-term conditions: maternal and neonatal effects of epilepsy. Br J Midwifery. 2017; 25:(5)301-7

Joint Epilepsy Council of the UK and Ireland. Epilepsy prevalence, incidence and statistics. 2011. (accessed 11 March 2018)

Joint Formulary Committee. Sodium Valproate. 2018a. (accessed 30 July 2018)

Joint Formulary Committee. Epilepsy. 2018b. (accessed 30 July 2018)

Kapoor D, Wallace S. Trends in maternal deaths from epilepsy in the United Kingdom: a 30-year retrospective review. Obstet Med. 2014; 7:(4)160-4

Kelso A, Willis A Caring for women with epilepsy. In: Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJ (eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2014

Kelso A, Willis A, Knight M Lessons on epilepsy and stroke. In: Knight M, Nair M, Tuffnell D (eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2017

Knight M, Nair M, Tuffnell D Saving Lives, Improving Mothers' Care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2013–15.(eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2017

Lamberts RJ, Thijs RD, Laffan A, Langan Y, Sander JW. Sudden unexpected death in epilepsy: People with nocturnal seizures may be at highest risk. Epilepsia. 2012; 53:(2)253-7

Maguire MJ, Jackson CF, Marson AG, Nolan SJ. Treatments for the prevention of Sudden Unexpected Death in Epilepsy (SUDEP). Cochrane Database Syst Rev. 2016; 7

Man SL, Petersen I, Thompson M, Nazareth I, Nazareth I, Thompson M. Antiepileptic drugs during pregnancy in primary care: a UK population based study. PLoS One. 2012; 7:(12)

Mclean B, Shankar R, Hanna J, Jory C, Newman C. Sudden unexpected death in epilepsy: measures to reduce risk. Pract Neurol. 2017; 17:(1)13-20

Meador KJ, Baker GA, Browning N Breastfeeding in children of women taking antiepileptic drugs: Cognitive outcomes at age 6 years. JAMA Pediatr. 2014; 168:(8)729-36

Medicines and Healthcare products Regulatory Agency. Valproate medicines (Epilim ▾, Depakote ▾): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met. 2018. (accessed 6 May 2018)

Michaelis R, Tang V, Wagner J Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life. Epilepsia. 2018; 59:(2)315-32

Morley K. Antiepileptic drug management during pregnancy: A shared decision approach. Br J Midwifery. 2016a; 24:(5)353-61

Optimising midwifery care for women with epilepsy. 2016b. (accessed 31 July 2018)

Maternity epilepsy shared care toolkit. 2018a. (accessed 31 July 2018)

Epilepsy. 2018b. (accessed 30 July 2018)

O' Rourke G, O' Brien JJ. Identifying the barriers to antiepileptic drug adherence among adults with epilepsy. Seizure. 2017; 45:160-8

Pashley S, O'Donoghue MF. The safety of anti-epileptic drug regimens: a qualitative study of factors determining the success of counselling women before conception. J Fam Plann Reprod Health Care. 2009; 35:(3)153-6

Petersen I, Collings SL, McCrea RL Antiepileptic drugs prescribed in pregnancy and prevalence of major congenital malformations: comparative prevalence studies. Clin Epidemiol. 2017; 9:(9)95-103

Epilepsy in Pregnancy [Green-top Guideline no. 68].London: RCOG; 2016a

Information for you: Epilepsy in Pregnancy.London: RCOG; 2016b

Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum [Green-top Guideline no. 69].London: RCOG; 2016c

Ruthirago D, Julayanont P, Karukote A, Shehabeldin M, Nugent K. Sudden unexpected death in epilepsy: ongoing challenges in finding mechanisms and prevention. Int J Neurosci. 2018; 018.1466780

Sanz E, Gómez-López T, Martínez-Quintas MJ. Perception of teratogenic risk of common medicines. Eur J Obstet Gynecol Reprod Biol. 2001; 95:(1)127-31

Diagnosis and management of epilepsy in adults: A national clinical guideline [SIGN no. 143].Edinburgh: SIGN; 2015

Clinical Guidance: Drug Interactions with Hormonal Contraception.London: FSRH; 2018

Tomson T, Battino D, Bonizzoni E Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol. 2011; 10:(7)609-17

US National Library of Medicine. Drugs and Lactation Database (LactMed). 2018. (accessed 30 July 2018)

Vajda FJE, O'Brien TJ, Graham JE, Hitchcock AA, Lander CM, Eadie MJ. Predicting epileptic seizure control during pregnancy. Epilepsy Behav. 2018; 78:91-5

Voinescu P, Pennell PB. Delivery of a Personalized Treatment Approach to Women with Epilepsy. Semin Neurol. 2017; 37:(6)611-23

Watkins L, Shankar R, Sander J. Identifying and mitigating Sudden Unexpected Death in Epilepsy (SUDEP) risk factors. Expert Rev Neurother. 2018; 18:(4)265-74 0.1080/14737175.2018.1439738

Widnes SF, Schjøtt J, Granas AG. Risk perception and medicines information needs in pregnant women with epilepsy – A qualitative study. Seizure. 2012; 21:(8)597-602

Xu Y, Nguyen D, Carcel C Frequency of a false positive diagnosis of epilepsy: A systematic review of observational studies. Seizure. 2016; 41:167-74

Epilepsy in pregnancy: The role of the midwife in risk management

02 September 2018
20 min read
Volume 26 · Issue 9


Epilepsy is a serious neurological disease that affects approximately 1 in 200 pregnancies in the UK. Despite the majority of women with epilepsy experiencing an uneventful maternity and postnatal year, there are recurring features for those who die or experience adverse outcomes. Risk factors for morbidity and mortality in maternities with epilepsy are often determined long before pregnancy occurs. It is imperative therefore that midwives prepare for the booking appointment, conduct effective history-taking, have the knowledge to prioritise referrals, share safety advice promptly and signpost women to develop risk minimisation strategies throughout the pregnancy continuum. This article includes the use of toolkits designed to assist with this process and incorporates the latest regulatory measures for valproate medicines. Increasing midwifery knowledge about risk awareness and prevention strategies for women with epilepsy is likely to result in reduced inequalities in multi-professional healthcare provision.

Epilepsy is the most common neurological disease to be found during pregnancy, and has a significant risk of morbidity and mortality to the woman and the developing fetus (Borgelt et al, 2016; Knight et al, 2017). It is characterised by seizures, which cause a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain (Fisher et al, 2014). The subsequent effect of seizures and treatment prescribed to reduce these symptoms is likely to have a significant impact on health-related quality of life for those with epilepsy and their families (Michaelis et al, 2018). Personalised treatment and management is essential, and requires calculation of risks and benefits of diagnostic and therapeutic options, which are frequently readjusted throughout a person's life (Voinescu and Pennell, 2017). Prevention of seizures and optimisation of treatment therefore should be paramount in pre-conception and pregnancy planning for all women with epilepsy of childbearing potential. Despite this recommendation, maternity mortality reports in the UK have repeatedly identified a high rate of maternal death in women with epilepsy who did not receive pre-conception counselling and, subsequently, did not have the involvement of an epilepsy nurse or specialist in their pregnancy care (Kelso and Willis, 2014).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

  • Monthly email newsletter