[6] Epilepsy in Pregnancy Flashcards
What percentage of the obstetric complications are affected by epilepsy?
~1%
How can pregnancy affect epilepsy?
Variable - in some cases can increase seizure frequency
What is thought to cause the increase in seizure frequency in epilepsy in pregnancy?
- Non-compliance with medication
- Sleep deprivation
How can epilepsy affect pregnancy?
- Increase perinatal loss rate
- Higher risk of congenital abnormalities
- Teratogenic effect of AED’s
Which types of epilepsy can particularly increase fetal loss rate?
- Tonic-clonic seizures
- Status epilepticus
What is the risk of congenital abnormalities in women with epilepsy?
3% (vs 1-2% in general population)
What is the risk of congenital abnormalities if a woman is taking AED’s?
4-9%
Which AED has the greatest risk to the fetus and should be avoided in women of reproductive age?
Sodium valproate
What are the risks of AED’s to the fetus?
- Congenital abnormalities
- IUGR
- Subtle long-term neuro-developmental affects
- Can induce Vitamin K deficiency
What are the main congenital abnormalities induced by AED’s?
- Neural tube defects
- Congenital heart defects
What is the result of vitamin K deficiency that can be induced by AED’s?
Increased risk of haemorrhagic disease of the newborn
How does the number of AED’s taken affect the risk to the fetus?
More AED’s further increases the risk
What AED’s are considered safest in pregnancy?
- Lamotrigine
- Carbamazepine
How can levels of AED vary during pregnancy?
They are lowered in pregnancy but rise in puerperium
How may varying levels of AED’s in pregnancy affect epilepsy control?
Different doses may be needed to be effective
What should women with epilepsy ideally receive pre-conception?
Counselling about the risks and medication review
What may happen in a pre-conception medication review for epilepsy?
- Altering of medications
- Delay pregnancy until safer regimen is established
What should women with epilepsy not do to their medication?
Stop abruptly due to fears about the fetus
Why should AED’s not be stopped abruptly in pregnancy?
The risk of uncontrolled epilepsy is often greater than AED’s
What dose of folic acid is given to women with epilepsy in pregnancy?
5mg
What frequency of growth scans may be required in epilepsy?
Serial growth scans
How can the risk of haemorrhagic disease of the newborn be reduced in patients taking AED’s that can cause vitamin K deficiency?
- Maternal vitamin K on last few weeks
- IM baby injections just after birth
Where should women with epilepsy deliver?
In hospital
Are seizures common in labour?
No
What advice should women with epilepsy be given after they have given birth?
- 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
Is breast feeding safe in most AED’s?
Yes
