Document Detail


Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society.
MedLine Citation:
PMID:  19398681     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy.
METHODS: Systematic review of relevant articles published between January 1985 and June 2007.
RESULTS: It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine and possible compared to phenytoin or lamotrigine. Compared to untreated WWE, it is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. It is probable that antiepileptic drug (AED) polytherapy as compared to monotherapy regimens contributes to the development of MCMs and to reduced cognitive outcomes. For monotherapy, intrauterine exposure to VPA probably reduces cognitive outcomes. Further, monotherapy exposure to phenytoin or phenobarbital possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7.
RECOMMENDATIONS: If possible, avoidance of valproate (VPA) and antiepileptic drug (AED) polytherapy during the first trimester of pregnancy should be considered to decrease the risk of major congenital malformations (Level B). If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered to prevent reduced cognitive outcomes (Level B). If possible, avoidance of phenytoin and phenobarbital during pregnancy may be considered to prevent reduced cognitive outcomes (Level C). Pregnancy risk stratification should reflect that the offspring of women with epilepsy taking AEDs are probably at increased risk for being small for gestational age (Level B) and possibly at increased risk of 1-minute Apgar scores of <7 (Level C).
Authors:
C L Harden; K J Meador; P B Pennell; W A Hauser; G S Gronseth; J A French; S Wiebe; D Thurman; B S Koppel; P W Kaplan; J N Robinson; J Hopp; T Y Ting; B Gidal; C A Hovinga; A N Wilner; B Vazquez; L Holmes; A Krumholz; R Finnell; D Hirtz; C Le Guen; ;
Publication Detail:
Type:  Journal Article; Practice Guideline; Research Support, Non-U.S. Gov't; Review     Date:  2009-04-27
Journal Detail:
Title:  Neurology     Volume:  73     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-14     Completed Date:  2009-08-07     Revised Date:  2014-09-13    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  133-41     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Abnormalities, Drug-Induced / etiology*
Anticonvulsants / adverse effects*,  contraindications*,  therapeutic use
Birth Weight / drug effects
Cognition Disorders / chemically induced*
Drug Therapy, Combination
Epilepsy / drug therapy*
Female
Humans
Infant, Newborn
Pregnancy
Pregnancy Complications / drug therapy*
Prenatal Exposure Delayed Effects
Risk
Valproic Acid / adverse effects,  contraindications,  therapeutic use
Grant Support
ID/Acronym/Agency:
R01 NS038455/NS/NINDS NIH HHS; R01 NS038455-09/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Anticonvulsants; 614OI1Z5WI/Valproic Acid
Comments/Corrections

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