Antiepileptic drug management during pregnancy: A shared decision approach
There is an increased risk of morbidity and mortality associated with sudden withdrawal of antiepileptic drugs (AEDs). A decision to change adherence behaviour in pregnancy may be related to overestimating the risk of teratogenicity, lack of pregnancy-related knowledge and a failure by health professionals to facilitate individualised, proactive pre-conception counselling for women with epilepsy of childbearing potential. To demonstrate how women can take part in the active management of their condition, this article explores a complex decision to reintroduce AEDs following the first trimester of pregnancy. The decision has been unravelled and the complexity behind it outlined by gathering pertinent information. The risks and benefits of recommencing AEDs were identified and the evidence critically appraised. The choice of alternatives was discussed and the consequences and clinical judgement related to the decision-making process explored. The decision was evaluated for potential health outcome, impact and implications for future practice.
It is estimated that there are 81 500 women of childbearing potential (aged 12–50 years) in England with a diagnosis of epilepsy who are prescribed antiepileptic drugs (AEDs) (National Institute for Health and Care Excellence (NICE), 2013). However, lack of pre-conception counselling and failure to refer women during pregnancy for specialist support is a recurring factor for the increased risk of maternal death associated with this condition. In the 3-year period 2009–12, seizures or epilepsy were associated with 14 maternal deaths in the UK during pregnancy and the first 6 weeks postnatal; a further 12 women died between 6 weeks postnatal and 1 year following birth (Knight et al, 2014). Women from often marginalised groups were at particular risk of morbidity, as well as women who were concerned about exposing their pregnancy to AEDs (Knight et al, 2014).
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