Pregnancy risks for the woman with epilepsy

doi:10.1017/CBO9780511545030.019

19 - Pregnancy risks for the woman with epilepsy

from Part V - Family planning, pregnancy, and parenting

Published online by Cambridge University Press: 02 November 2009

Mark Yerby and

Yasser Y. El-Sayed

Edited by

Martha J. Morrell and

Kerry L. Flynn

Show author details

Mark Yerby: Affiliation:
North Pacific Epilepsy Research, 2455 Northwest Marshall Street, Portland, OR 97210, USA
Yasser Y. El-Sayed: Affiliation:
Department of Gynecology and Obstetrics, Stanford University Medical Center, Standford Hospital, 300 Pasteur Drive, Stanford, CA 94305
Martha J. Morrell: Affiliation:
Columbia University, New York
Kerry L. Flynn: Affiliation:
Columbia-Presbyterian Cancer Center, New York

Book contents

Get access

Summary

Making the decision to have a child can be joyous, as well as frightening. Every parent hopes that the pregnancy will be uncomplicated and the child will be born healthy. Women with epilepsy may be especially concerned that the risk of pregnancy complications and birth defects could be higher because of seizures and because the baby will be exposed to antiepileptic drugs. However, many women with epilepsy (and their physicians) believe these risks to be higher than they really are. Therefore, it is especially important for women with epilepsy to have access to comprehensive and accurate information in order to make an informed and appropriate choice. In addition, strategies to optimize seizure control, minimize medication exposure, and provide essential preconceptional vitamin supplementation need to be in place before pregnancy occurs. The information contained in the next two chapters should provide a good basis for discussion among women with epilepsy, their neurologists and obstetricians/ gynecologists.

Dr Mark Yerby is a faculty member at the University of Oregon and an epilepsy expert who lectures widely on this topic. Dr El-Sayed, who provides the information contained in the boxes in Chapters 19 and 20, is an Assistant Professor in Obstetrics and Gynecology at Stanford University. He has special expertise in the gynecological and obstetrical care of women with epilepsy.

MJM

Reproductive health care is important for every woman. For a woman with epilepsy, regular appointments with her neurologist do not replace the essential visits to her obstetrician/gynecologist.

Keywords

antiepileptic drugs epilepsy epileptic mothers infant mortality pregnant women pregnancy risks neonatal hemorrhage

Type: Chapter
Information: Women with Epilepsy
A Handbook of Health and Treatment Issues
, pp. 203 - 214

DOI: https://doi.org/10.1017/CBO9780511545030.019 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Annegers, JF, Baumgartner, KB, Hauser, WA. Epilepsy, antiepileptic drugs and the risk of spontaneous abortion. Epilepsia 1988; 29(4):451–8CrossRef Google Scholar PubMed

Annegers, JF, Elveback, LR, Hauser, WA. Do anticonvulsants have a teratogenic effect?Arch Neurol 1974; 31:364–73CrossRef Google Scholar PubMed

Annegers, JF, Hauser, WA, Elveback, LR. Seizure disorders in offspring of parents with a history of seizures – maternal–paternal difference?Epilepsia 1976; 17(1):1–9CrossRef Google Scholar PubMed

Argent, AC, Rothberg, AD, Pienaar, N.Precursor prothrombin status in the mother infant pairs following gestational anticonvulsant therapy. Pediatr Pharmacol 1984; 4:183–7Google Scholar

Bardy AH. Seizure frequency in epileptic women during pregnancy and the puerperium: results of the prospective Helsinki Study. In Epilepsy, Pregnancy, and the Child, ed. D Janz, L Bossi, M Dam, H Heige, A Richens, D Schmidt. Raven Press, New York, 1982, pp. 27–31

Bethnod, M, Frederich, A.Les enfants des antiepileptiques. Pediatrie 1975; 30:227–48Google Scholar

Bjerkdal, T, Bahna, SL.The course and outcome of pregnancy in women with epilepsy. Acta Obstet Gynecol Scand 1973; 52:245–8CrossRef Google Scholar

Burnett, CWF.A survey of the relation between epilepsy and pregnancy. J Obstet Gynecol 1946; 53:539–56Google Scholar

Czeizel, AE, Dudas, I.Prevention of the first occurrence of neural tube defects by preconceptual vitamin supplements. N Engl J Med 1992; 327:1832–5CrossRef Google Scholar

Dam, M, Christiansen, J, Munck, O. Antiepileptic drugs: metabolism in pregnancy. Clin Pharmacokinet 1979; 4(1):53–62CrossRef Google Scholar PubMed

Dansky, LV, Andermann, E, Rosenblatt, D. Anticonvulsants, folate levels, and pregnancy outcome: a prospective study. Ann Neurol 1987; 21:176–82CrossRef Google Scholar PubMed

Davies, VA, Argent, AC, Staub, H.Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985; 1(8421):126–8CrossRef Google Scholar PubMed

Deblay, MF, Vert, P, Andre, M. Transplacental vitamin K prevents hemorrhagic disease of infants of epileptic mothers. Lancet 1982; 1:1247CrossRef Google Scholar

Eadie, MJ, Lander, CM, Tyrer, JH.Plasma drug level monitoring in pregnancy. Clin Pharmacokinet 1977; 2(6):427–36CrossRef Google Scholar PubMed

Egenaes J. Outcome of pregnancy in women with epilepsy, Norway 1967–1978: complications during pregnancy and delivery. In Epilepsy, Pregnancy, and the Child, ed. D Janz, L Bossi, M Dam, H Heige, A Richens, D Schmidt. Raven Press, New York, 1982, pp. 81–5

Higgins, TA, Commerford, JB.Epilepsy and pregnancy. J Irish Med Assoc 1974; 67(11): 317–20Google Scholar

Hill RM, Tennyson L. Premature delivery, gestational age, complications of delivery, vital data at birth on newborn infants of epileptic mothers: Review of the literature. In Epilepsy, Pregnancy, and the Child, ed. D Janz, L Bossi, M Dam, et al. Raven Press, New York, 1982, pp. 167–73

Holmes, GL, Weber, D.Effect of seizures during pregnancy on seizure susceptibility in offspring. Epilepsia 1985; 26:421–3CrossRef Google Scholar PubMed

Janz, D.Antiepileptic drugs and pregnancy: altered utilization patterns and teratogenesis. Epilepsia 1982; 23(Suppl. 1):S53–S62CrossRef Google Scholar PubMed

Janz, D, Fuchs, V.Are antiepileptic drugs harmful when given during pregnancy?Ger Med Mon 1964; 9:20–2Google Scholar

Kalen, B.A register study of maternal epilepsy and delivery outcome with special reference to drug use. Acta Neurol Scand 1986; 73:253–9CrossRef Google Scholar

Kalter, H, Warkany, J.Congenital malformations. N Engl J Med 1983; 308:491–7CrossRef Google Scholar PubMed

Knight, AH, Rhind, EG.Epilepsy and pregnancy: a study of 153 pregnancies in 59 patients. Epilepsia 1975; 16:99–110CrossRef Google Scholar PubMed

Koch S, Gopfert-Geyer I, Hauser A, et al. Neonatal behavior disturbances in infants of epileptic women treated during pregnancy. In Epidemiology, Early Detection and Therapy, and Environmental Factors, ed. A Liss. Alan R. Liss Inc., New York, 1985, pp. 453–61

Lawrence, KM, James, J, Miller, MH, Tennant, GB, Campbell, H.Double-blind randomized controlled trial of folate treatment before conception to prevent recurrence of neural tube defects. BMJ 1981; 282:1509–11CrossRef Google Scholar

Leonard, CH, Kilpatrick, SJ, Schlueter, MA. Outcome of infants born at 24–26 weeks' gestation: II. Neurodevelopmental outcome. Obstet Gynecol 1997; 90:809–14Google Scholar

Levy, RH, Yerby, MS.Effects of pregnancy on antiepileptic drug utilization. Epilepsia 1985; 26(Suppl. 1):525–57CrossRef Google Scholar PubMed

Lindhout, D, Meinardi, H, Meijer, WA, Nau, H.Antiepileptic drugs and teratogenesis in two consecutive cohorts: changes in prescription policy paralleled by changes in pattern of malformations. Neurology 1992; 42(Suppl. 5):94–110Google Scholar PubMed

Monson, RR, Rosenberg, L, Hartz, SC. Anticonvulsants and parental epilepsy in the development of birth defects. Lancet 1976; 1(7954):272–5Google Scholar

Montouris, GD, Fenichel, GM, McLain, LW.The pregnant epileptic: a review and recommendations. Arch Neurol 1979; 36(10):601–3CrossRef Google Scholar PubMed

Mountain, KR, Hirsch, J, Gallus, AS.Maternal coagulation defect due to anticonvulsant treatment in pregnancy. Lancet 1970; 1:265–8CrossRef Google Scholar

MRC Vitamin Study Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet 1991; 338:131–7CrossRef

Nakane, Y, Oltuma, T, Takahashi, R. Multi-institutional study on the teratogenicity and fetal toxicity of anticonvulsants: a report of a collaborative study group in Japan. Epilepsia 1980; 21:663–80CrossRef Google Scholar

Nau, H, Kuhnz, W, Egger, HJ. Anticonvulsants during pregnancy and lactation: transplacental, maternal and neonatal pharmacokinetics. Clin Pharmacokinet 1981; 7:508–43CrossRef Google Scholar

Nelson, KB, Ellenberg, JH.Maternal seizure disorder, outcome of pregnancy and neurological abnormalities in the children. Neurology 1982; 32:1247–54CrossRef Google Scholar

Otani, K.Risk factors for the increased seizure frequency during pregnancy and the puerpurium. Fol Psychiatr Neurol Japon 1985; 39:33–44Google Scholar

Ottman, R, Annegers, JF, Hauser, WA, Kurland, LT.Higher risk of seizures in offspring of mothers than fathers with epilepsy. Am J Hum Genet 1988; 43:357–64Google Scholar PubMed

Perruca, E, Crema, A.Plasma protein binding of drugs in pregnancy. Clin Pharmacokinet 1981; 7:336–52CrossRef Google Scholar

Philbert, A, Dam, M.The epileptic mother and her child. Epilepsia 1982; 23:85–99CrossRef Google Scholar PubMed

Ramsay, RE, Strauss, RG, Wilder, BJ, Willmore, LJ.Status epilepticus in pregnancy: effect of phenytoin malabsorption on seizure control. Neurology 1978; 28:85–9CrossRef Google Scholar PubMed

Sabin, M, Oxorn, H.Epilepsy and pregnancy. Obstet Gynecol 1956; 7:175–99Google Scholar

Schmidt, D, Canger, R, Avanzini, G. Change of seizure frequency in pregnant epileptic women. J Neurol Neurosurg Psychiatry 1983; 46:751–5CrossRef Google Scholar PubMed

Schmidt, D, Nau, H, Kock, S. Teratogenic and pharmacokinetic studies of primidone during pregnancy and in the offspring of epileptic women. Acta Paediatr Scand 1982; 71(2):301–11Google Scholar

Smithells, RW, Nevin, NC, Seller, MJ.Further experience of vitamin supplementation for prevention of neural tube defect recurrences. Lancet 1972; 2:839–43Google Scholar

Speidel, BD, Meadow, SR.Maternal epilepsy and abnormalities of the fetus and the newborn. Lancet 1972; 2:839–43CrossRef Google Scholar PubMed

Srinivasan, G, Seeler, RA, Tiruvury, A. Maternal anticonvulsant therapy and hemorrhagic disease of the newborn. Obstet Gynecol 1982; 59:250–2Google Scholar PubMed

Stumpf, DA, Frost, M.Seizures, anticonvulsants, and pregnancy. Am J Dis Child 1978; 132:746–8Google Scholar

Suter, C, Klingman, WO.Seizure states and pregnancy. Neurology 1957; 7:105–18CrossRef Google Scholar

Svigos, JM, Aust, NZ.Epilepsy and pregnancy. J Obstet Gynaecol 1984; 24:182–5Google Scholar

Tanganelli, P, Regesta, G.Epilepsy, pregnancy, and major birth anomalies: an Italian prospective, controlled study. Neurology 1992; 42(Suppl. 5):89–93Google Scholar PubMed

Teramo, K, Hiilesmaa, VK, Bardy, A. Fetal heart rate during a maternal grand mal epileptic seizure. J Perinat Med 1979; 7:3–5CrossRef Google Scholar PubMed

Creveld, S.Nouveaux aspects de la maladie hemorragique de nouveau ne. Ned Tijdschr Geneeskd 1957; 101:2109–12Google Scholar

Vergel, RG, Sanchez, LR, Heredero, BL, Rodriguez, PL, Martinez, AJ.Primary prevention of neural tube defects with folic acid supplementation: Cuban experience. Prenat Diagn 1990; 10(3):149–52CrossRef Google Scholar PubMed

Vert AP, Deblay MF. Infants of epileptic mothers. In Intensive Care in the Newborn II, ed. L Stern. Masson, New York, 1979, pp. 347–60

Walker, NP, Bardlow, BA, Atkinson, PM.A rapid chromogenic method for the determination of prothrombin precursor in the plasma. Am J Clin Pathol 1982; 78:777–80CrossRef Google Scholar

Yerby, MS, Friel, PN, McCormick, KB. Pharmacokinetics of anticonvulsants in pregnancy: alterations in plasma protein binding. Epilepsy Res 1990; 5:223–8CrossRef Google Scholar PubMed

Yerby, MS, Friel, PN, Miller, DQ.Carbamazepine protein binding and disposition in pregnancy. Ther Drug Monit 1985; 7:269–73CrossRef Google Scholar PubMed

Yerby, MS, Koepsell, T, Daling, J.Pregnancy complications and outcomes in a cohort of women with epilepsy. Epilepsia 1985; 26:631–5CrossRef Google Scholar

Book contents

19 - Pregnancy risks for the woman with epilepsy

Summary

Keywords

Access options

References

Save book to Kindle

Save book to Dropbox

Save book to Google Drive