Pregnancy

Question 1

Folate supplementation

Answer 1

If continues anti-epileptic
5mg daily
Reduce risk of neural tube defects
Taken before conception and until week 12 of pregnancy (1st trimester)

Question 2

Unplanned pregnancy

Answer 2

GP referral if taking valproate

Question 3

Seizure in 2nd half of pregnancy whilst taking antiepileptic

Answer 3

Assess for eclampsia before changing any antiepileptic treatment
Treat status epilepticus

Question 4

Vitamin K birth injections for baby

Answer 4

reduced risk of neonatal hemorrhages

Question 5

Withdrawal effects in newborn

Answer 5

Benzodiazepines

Phenobarbital

Question 6

Breastfeeding

Answer 6

Monotherapy = encourage breast-feeding 
Combined = assess

Question 7

Teratogenic drugs

Answer 7

highest risk = valproate / valproic acid = minor / major congenital malformations and long-term development disorders

increased risk = carbamazepine, phenytoin, phenobarbital, primidone, lamotrigine (CP3L)

Cleft palate = topiramate in 1st trimester

Question 8

Reduce effective contraception

Answer 8

Carbamazepine

enzyme-inducing antiepileptic

Question 9

Plasma concentration changes

Answer 9

dose adjustments

1. based on plasma drug conc : phenytoin, carbamazepine, lamotrigine
2. based on clinical basis: other

Question 10

Monitor foetal growth

Answer 10

Topiramate

Levetiracetam

Question 11

Refer to specialist

Answer 11

If planning pregnancy - usually withdrawal then restart after 1st trimester with MONOTHERAPY
Unplanned pregnancy
No effective contraception and on valproate

Question 12

Who to tell?

Answer 12

notify the UK epilepsy and pregnancy register