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Health Corners
Post Partum Issues in Women with Epilepsy

Post Partum

  • Monitoring of maternal antiepileptic drug levels should continue postpartum.

  • Levels gradually return to baseline by 12 weeks after delivery.

  • Mothers should be advised to avoid sleep deprivation.

  • Breast-feeding and child-care issues should be discussed.

Breast Feeding

  • Many women with epilepsy can breast-feed.

  • The concentration of Anti Epileptic Drugs (AED) in breast milk is determined by its plasma level and its degree of protein binding.

  • Higher protein binding means that less is present in breast milk.

  • Both PHT & VA are highly protein-bound, so only low levels of drug are present in breast milk.

  • PHT is also very poorly absorbed from an infant's GI tract.

  • Breast-feeding is permissible with phenytoin or valproic acid.

  • CBZ & PB are present at higher levels in breast milk, and breast-feeding is less advisable with these agents.

Serum Concentrations of AEDs in Breast Milk

  • Carbamazepine 40%

  • Ethosuximide 90%

  • Phenobarbital 36%

  • Phenytoin sodium 18%

  • Primidone 70%

  • Valproic acid 5%

  • Gabapentin, Lamotrigine, Topiramate Not known

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