2023, Number 02
<< Back Next >>
Ginecol Obstet Mex 2023; 91 (02)
Epilepsy and pregnancy: particularities and treatment
Lozano-Vidal M, Carmona-Domínguez E
Language: Spanish
References: 32
Page: 109-118
PDF size: 212.85 Kb.
ABSTRACT
Background: The prevalence of epilepsy in pregnant women is 0.3 to 0.5%. Although
it is a low frequency disease, it is important to know how pregnancy modifies
the course of the disease and how the disease modifies the course of pregnancy and
what is the safety of treatments during pregnancy and what are the current obstetric
consensuses in this regard.
Objective: To update knowledge about how pregnancy modifies the course of the
disease, how the disease modifies the course of pregnancy, how safe are the treatments
during pregnancy and the current obstetric consensus in this respect.
Methodology: Literature review conducted in two databases (PubMed and Scopus)
with the following search criteria (MeSH): "epilepsy'' and "pregnancy'' of articles
published between 2015 and May 2022, written in English or Spanish: meta-analyses,
systematic reviews, narratives or clinical trials.
Results: 310 records were identified. After elimination for duplication and other
causes, 20 articles were selected, plus others used to complement the topic.
Conclusions: Pregnancy in a patient with epilepsy should be considered high
risk and therefore follow-up should be appropriate. Pregnancy planning is essential in
order to indicate the appropriate antiepileptic treatment and folic acid supplementation,
if necessary.
REFERENCES
Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE OfficialReport: A practical clinical definition of epilepsy. Epilepsia 2014; 55 (4): 475-82. doi:10.1111/EPI.12550
Epilepsia. https://www.who.int/en/news-room/factsheets/detail/epilepsy
Viinikainen K, Heinonen S, Eriksson K, Kälviäinen R.Community-based, prospective, controlled study ofobstetric and neonatal outcome of 179 pregnancies inwomen with epilepsy. Epilepsia 2006; 47 (1): 186-92.doi:10.1111/J.1528-1167.2006.00386.X
Harden CL, Hopp J, Ting TY, et al. Management issues forwomen with epilepsy-Focus on pregnancy (an evidencebasedreview): I. Obstetrical complications and change inseizure frequency: Report of the Quality Standards Subcommitteeand Therapeutics and Technology AssessmentSubcommittee of the American Academy of Neurologyand the American Epilepsy Society. Epilepsia 2009; 50 (5):1229-36. doi:10.1111/J.1528-1167.2009.02128.X
Mauri Llerda JA, Suller Marti A, de la Peña Mayor P, et al.The Spanish Society of Neurology’s official clinical practiceguidelines for epilepsy. Special considerations in epilepsy:Comorbidities, women of childbearing age, and elderlypatients. Neurol 2015; 30 (8): 510-17. doi:10.1016/J.NRLENG.2014.08.002
Hammarberg K, Stocker R, Romero L, Fisher J. Pregnancyplanning health information and service needs of womenwith chronic non-communicable conditions: a systematicreview and narrative synthesis. BMC Pregnancy Childbirth2022; 22 (1). doi:10.1186/S12884-022-04498-1
McGrath A, Sharpe L, Lah S, Parratt K. Evaluation of a DecisionAid for Women with Epilepsy Who Are ConsideringPregnancy: A Randomized Controlled Trial. Med Decis Making2017; 37 (5): 589-99. doi:10.1177/0272989X17697304
Whybrow R, Webster LM, Seed PT, Sandall J, Chappell LC.The effectiveness of decision aids for pregnancy relateddecision-making in women with pre-pregnancy morbidity;systematic review and meta-analysis. BMC PregnancyChildbirth 2022; 22 (1). doi:10.1186/S12884-022-04402-X
Kashif T, Fathima N, Usman N, Qaseem A, Jayaraj JS. Womenwith Epilepsy: Anti-epileptic Drugs and Perinatal Outcomes.Cureus 2019; 11 (9). doi:10.7759/CUREUS.5642
Wilson RD, O’Connor DL. Maternal folic acid and multivitaminsupplementation: International clinical evidencewith considerations for the prevention of folate-sensitivebirth defects. Prev Med Reports 2021; 24: 101617.doi:10.1016/J.PMEDR.2021.101617
Shahla M, Hijran B, Sharif M. The course of epilepsy andseizure control in pregnant women. Acta Neurol Belgica2018; 118(3):459-464. doi:10.1007/S13760-018-0974-0
Viale L, Allotey J, Cheong-See F, et al. Epilepsy in pregnancyand reproductive outcomes: a systematic review and metaanalysis.Lancet 2015; 386 (10006):1845-52. doi:10.1016/S0140-6736(15)00045-8
Chen D, Hou L, Duan X, Peng H, Peng B. Effect of epilepsy inpregnancy on fetal growth restriction: a systematic reviewand meta-analysis. Arch Gynecol Obstet 2017; 296 (3):421-27. doi:10.1007/S00404-017-4404-Y
Allotey J, Aroyo-Manzano D, Lopez P, Viale L, Zamora J,Thangaratinam S. Global variation in pregnancy complicationsin women with epilepsy: A meta-analysis. Eur J ObstetGynecol Reprod Biol 2017; 215: 12-19. doi:10.1016/j.ejogrb.2017.05.016
Lavu A, Vaccaro C, Shouman W, Severini SA, Eltonsy S. Antiepilepticdrug exposure during pregnancy and neonatalbirth weight outcomes: protocol for a systematic reviewand meta-analysis. Syst Rev 2021; 10 (1). doi:10.1186/S13643-021-01711-8
Veroniki AA, Cogo E, Rios P, et al. Comparative safety of antiepilepticdrugs during pregnancy: a systematic review andnetwork meta-analysis of congenital malformations andprenatal outcomes. BMC Med 2017; 15 (1). doi:10.1186/S12916-017-0845-1
Morton A. Pregnancy complicated by neurological andneurosurgical conditions – The evidence regardingmode of delivery: https://doi-org.bvsspa.idm.oclc.org/101177/1753495X211000176. 2021;15(1):11-18.doi:10.1177/1753495X211000176
McElrath TF, Druzin ML, Van Marter LJ, et al. The obstetricalcare and delivery experience of women withepilepsy in the MODEAD Study. Am J Perinatol 2022.doi:10.1055/A-1788-4791
Weston J, Bromley R, Jackson CF, et al. Monotherapytreatment of epilepsy in pregnancy: Congenital malformationoutcomes in the child. Cochrane Database SystRev 2016; 2016 (11). doi:10.1002/14651858.CD010224.PUB2/MEDIA/CDSR/CD010224/IMAGE_N/NCD010224-CMP-019-04.PNG
Knight R, Wittkowski A, Bromley RL. Neurodevelopmentaloutcomes in children exposed to newer antiseizure medications:A systematic review. Epilepsia 2021; 62 (8): 1765-79.doi:10.1111/EPI.16953
Scheuerle AE, Holmes LB, Albano JD, et al. LevetiracetamPregnancy Registry: Final results and a review of the impactof registry methodology and definitions on the prevalenceof major congenital malformations. Birth defects Res 2019;111 (13): 872-87. doi:10.1002/BDR2.1526
Pariente G, Leibson T, Shulman T, Adams-Webber T, BarzilayE, Nulman I. Pregnancy outcomes following in utero exposureto lamotrigine: A systematic review and meta-analysis.CNS Drugs 2017; 31. doi:10.1007/s40263-017-0433-0
Veroniki AA, Rios P, Cogo E, et al. Comparative safetyof antiepileptic drugs for neurological development inchildren exposed during pregnancy and breast feeding: asystematic review and network meta-analysis. BMJ 2017; 7(7): e017248. doi:10.1136/BMJOPEN-2017-017248
Athar F, Ehsan M, Farooq M, et al. Adverse Fetal and NeonatalOutcomes following in-utero exposure to Oxcarbazepine:A Systematic Review and Meta-Analysis. Br J ClinPharmacol 2022. doi:10.1111/BCP.15413
Alsaad AMS, Chaudhry SA, Koren G. First trimester exposureto topiramate and the risk of oral clefts in the offspring:A systematic review and meta-analysis. Reprod Toxicol.2015;53:45-50. doi:10.1016/J.REPROTOX.2015.03.003
Tomson T, Battino D, Perucca E. Teratogenicity of antiepilepticdrugs. Curr Opin Neurol. 2019; 32 (2): 246-52.doi:10.1097/WCO.0000000000000659
Gynaecologists RC of O and. Epilepsy in pregnancy. https://www.rcog.org.uk/media/rzldnacf/gtg68_epile.
Epilepsia y embarazo Guía práctica de asistencia publicadaen 2008. https://sego.es/Buscador
Epilepsies in children, young people and adults NICE guideline.Published online 2022. Accessed June 7, 2022. www.nice.org.uk/guidance/ng217
Mauri Llerda JA, Suller Marti A, de la Peña Mayor P, et al.Guía oficial de la Sociedad Española de Neurología de prácticaclínica en epilepsia. Epilepsia en situaciones especiales:comorbilidades, mujer y anciano. Neurología 2015; 30 (8):510-517. doi:10.1016/J.NRL.2014.08.002
Yadav U, Kumar P, Gupta S, Rai V. Distribution of MTHFRC677T Gene Polymorphism in Healthy North Indian Populationand an Updated Meta-analysis. Indian J Clin Biochem2016; 32 (4): 399-410. doi:10.1007/S12291-016-0619-0
Ferrazzi E, Tiso G, Di Martino D. Folic acid versus 5- methyltetrahydrofolate supplementation in pregnancy. Eur J ObstetGynecol Reprod Biol 2020; 253: 312-319. doi:10.1016/J.EJOGRB.2020.06.012