Valproate should be avoided in women with epilepsy who are pregnant, according to new guidelines developed by the American Academy of Neurology and the American Epilepsy Society.1 This medication has been shown to increase the risk of fetal malformations and decreased cognitive skills in children, whether used by itself or with other medications, according to guideline author Cynthia Harden, MD, director of the Epilepsy Division at the University of Miami’s Miller School of Medicine.
Mary Katherine Albritton, Cynthia Harden, MD, and Gary Gronseth, MD, spoke at the first press briefing of this year’s American Academy of Neurology Annual Meeting taking place this week in Seattle. Harden and Gronseth cosponsored new practice guidelines pertaining to pregnancy and women with epilepsy. Albritton gave the patient’s perspective.
The following guidelines are also recommended for pregnant women with epilepsy:
- Patients should not take more than 1 epilepsy drug at a time, because this may increase the risk of birth defects.
- Blood tests are recommended to check seizure medication levels, which can fluctuate during pregnancy.
- Phenytoin and phenobarbital should also be avoided because they have been associated with decreased cognitive skills in children of mothers who took these drugs during pregnancy.
- Patients should not smoke, because smoking substantially increases the risk of premature contractions and premature labor.
- To further prevent birth defects, women should take 400 micrograms of folic acid daily.
- Patients should not stop taking their medication without first consulting a physician.
- Women who intend to become pregnant should consult their physician at least 6 months before pregnancy.
According to Harden, most persons with epilepsy have well-controlled seizures, are otherwise healthy, and expect to participate fully in life experiences, including pregnancy. The results of this study also showed that women with epilepsy are not at a substantially increased risk for having a cesarean delivery, late pregnancy bleeding, or premature contractions or premature labor and delivery. Also, if a woman is seizure-free 9 months before she becomes pregnant, it is unlikely that she will have seizures during the pregnancy.
1. Harden CL, Hopp J, Ting TY, et al. Practice parameter update: management issues for women with epilepsy—focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency. Neurology. Accessed at: http://www.neurology.org/cgi/rapidpdf/WNL.0b013e3181a6b2f8v1.pdf. April 28, 2009.