[6] Epilepsy in Pregnancy

Question 1

What percentage of the obstetric complications are affected by epilepsy?

Answer 1

~1%

Question 2

How can pregnancy affect epilepsy?

Answer 2

Variable - in some cases can increase seizure frequency

Question 3

What is thought to cause the increase in seizure frequency in epilepsy in pregnancy?

Answer 3

• Non-compliance with medication

- Sleep deprivation

Question 4

How can epilepsy affect pregnancy?

Answer 4

• Increase perinatal loss rate
• Higher risk of congenital abnormalities
• Teratogenic effect of AED’s

Question 5

Which types of epilepsy can particularly increase fetal loss rate?

Answer 5

• Tonic-clonic seizures

- Status epilepticus

Question 6

What is the risk of congenital abnormalities in women with epilepsy?

Answer 6

3% (vs 1-2% in general population)

Question 7

What is the risk of congenital abnormalities if a woman is taking AED’s?

Answer 7

4-9%

Question 8

Which AED has the greatest risk to the fetus and should be avoided in women of reproductive age?

Answer 8

Sodium valproate

Question 9

What are the risks of AED’s to the fetus?

Answer 9

• Congenital abnormalities
• IUGR
• Subtle long-term neuro-developmental affects
• Can induce Vitamin K deficiency

Question 10

What are the main congenital abnormalities induced by AED’s?

Answer 10

• Neural tube defects

- Congenital heart defects

Question 11

What is the result of vitamin K deficiency that can be induced by AED’s?

Answer 11

Increased risk of haemorrhagic disease of the newborn

Question 12

How does the number of AED’s taken affect the risk to the fetus?

Answer 12

More AED’s further increases the risk

Question 13

What AED’s are considered safest in pregnancy?

Answer 13

• Lamotrigine

- Carbamazepine

Question 14

How can levels of AED vary during pregnancy?

Answer 14

They are lowered in pregnancy but rise in puerperium

Question 15

How may varying levels of AED’s in pregnancy affect epilepsy control?

Answer 15

Different doses may be needed to be effective

Question 16

What should women with epilepsy ideally receive pre-conception?

Answer 16

Counselling about the risks and medication review

Question 17

What may happen in a pre-conception medication review for epilepsy?

Answer 17

• Altering of medications

- Delay pregnancy until safer regimen is established

Question 18

What should women with epilepsy not do to their medication?

Answer 18

Stop abruptly due to fears about the fetus

Question 19

Why should AED’s not be stopped abruptly in pregnancy?

Answer 19

The risk of uncontrolled epilepsy is often greater than AED’s

Question 20

What dose of folic acid is given to women with epilepsy in pregnancy?

Answer 20

5mg

Question 21

What frequency of growth scans may be required in epilepsy?

Answer 21

Serial growth scans

Question 22

How can the risk of haemorrhagic disease of the newborn be reduced in patients taking AED’s that can cause vitamin K deficiency?

Answer 22

• Maternal vitamin K on last few weeks

- IM baby injections just after birth

Question 23

Where should women with epilepsy deliver?

Answer 23

In hospital

Question 24

Are seizures common in labour?

Answer 24

No

Question 25

What advice should women with epilepsy be given after they have given birth?

Answer 25

• Don’t bath the baby on their own
• Change the baby on the floor
• Don’t do things that would endanger the baby if they lost consciousness

Question 26

Is breast feeding safe in most AED’s?

Answer 26

Yes