Epilepsy in pregnancy

Question 1

What is the pre-conception management of women with epilepsy?

Answer 1

High dose folic acid 5mg OD from preconception to 12w

Reduce to monotherapy where possible

Preferred AED: LAMOTRIGINE

Use lowest effective dose

Question 2

What congenital defect is associated with Sodium Valproate?

Answer 2

Neural tube defects
Neurodevelopmental delay

Question 3

What congenital defect is associated with Phenytoin?

Answer 3

Cardiac malformation
Cleft palate

Question 4

What congenital defect is associated with Carbamezapine?

Answer 4

Cleft palate
(Considered least teratogenic of older AEDs)

Question 5

What is the antenatal management of women with epilepsy?

Answer 5

Arrange joint epilepsy + obstetric clinic
Serial growth scans every 4w from 28-36w

NO need to monitor AED levels routinely

Question 6

What is the postnatal management of women with epilepsy?

Answer 6

Encourage breastfeeding
Provide infö on safe handling of the neonate
Restart contraception
Continue AEDs
If dose increased in pregnancy, review within 10d to avoid toxicity

Question 7

What anti-epileptic drugs can be used whilst breastfeeding?

Answer 7

All
(Except barbiturates)