Epilepsy and Pregnancy Can Coexist

Summary and Comment |
September 15, 2015

Epilepsy and Pregnancy Can Coexist

  1. Eleanor Bimla Schwarz, MD, MS

With or without antiepileptic medications, epilepsy raises risk for certain adverse pregnancy outcomes; nonetheless, healthy pregnancies are well within reach.

  1. Eleanor Bimla Schwarz, MD, MS

Women with epilepsy often wonder how their disease might affect pregnancy outcomes. To summarize the existing literature on associations between epilepsy and reproductive outcomes, researchers conducted a systematic review and meta-analysis of observational studies of pregnant women with epilepsy published within the last 25 years.

In 39 articles that included >2.8 million pregnancies, women with epilepsy had significantly increased risk for miscarriage, hemorrhage, hypertensive disorders, labor induction, caesarean section, delivery at <37 weeks' gestation, and fetal growth restriction compared with women without the disorder. However, rates of gestational diabetes, early preterm birth, fetal or perinatal death, and neonatal intensive care unit (NICU) admissions did not differ among women with and without epilepsy. Antiepileptic medication use during pregnancy resulted in few significant differences in outcomes; however, hemorrhage, fetal growth restriction, and NICU admissions were more common with medication use.

Comment

Despite these increased relative risks for adverse outcomes, when pregnancy is desired, women with epilepsy can be reassured that most can have healthy pregnancies. Such women should be encouraged to begin folic acid supplementation and are advised to avoid valproate in favor of a less teratogenic antiepileptic medication. Nonetheless, because maternal mortality is 10 times higher for women with epilepsy, concerted efforts to prevent undesired pregnancy are warranted. Given that some antiepileptic medications reduce the effectiveness of hormonal contraceptives, reproductive counseling for women with epilepsy should always include information about the safety and superior effectiveness of intrauterine contraceptives, which are not susceptible to such interactions.

Editor Disclosures at Time of Publication

  • Disclosures for Eleanor Bimla Schwarz, MD, MS at time of publication Grant / Research support Veterans Health Administration; Agency for Healthcare Research and Quality Editorial boards Contraception

Citation(s):

Reader Comments (1)

SCOTT GOFF, MD Physician, Neurology, Consultant

The article is well written, but when I read "***epilepsy raises risk for certain adverse pregnancy outcomes***", I noted an omission to consider when counseling females who have seizure disorders. Namely, a thorough medical history is needed as it pertains to their epilepsy. I have had several pts who have primary generalized tonic-clonic epilepsy that is, most certainly, genetically linked. From discussions with pts ( which took several sessions trying to obtain answers to this delicate issue ), the patient's parents were related ( cousin to cousin ). The parents married and had offspring. The parents had four children with a 50% rate of epilepsy in the offspring and now one daughter's son has just started to present with epilepsy. Their foreign-land culture, it is accepted for close family marriages. As we all know from genetics 101, Mother Nature prefers genetic diversity; when that is not followed, harmful mutation(s) occur at a much greater rate than the norm.

So, in closing, the article's "***reproductive outcomes***" should be prefaced with counseling of: should a pregnancy even take place? Can this chain of seizure disorder from parent to child to 2nd generation child be broken using a "I advise against getting pregnant". A delicate discussion, indeed, but if the chain is to be broken - this is the only way until a genetic reprogramming can be developed in some future decade.

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