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Epilepsy & Pregnancy

  • Epilepsy is the most common neurological disorder in pregnant women

  • Most pregnancies are routine, and most of the children delivered are healthy

  • However, both seizures and antiepileptic drugs can adversely affect the foetus

  • Women should undergo evaluation by their neurologist regularly during pregnancy.

  • Serum AED levels should be monitored closely and adjusted if seizures occur.

  • Both free and total levels of PHT & CBZ should be checked.

AED levels in pregnancy

  • Drug levels decline during pregnancy owing to changes in liver metabolism, renal clearance, volume of distribution, and absorption.

  • Free levels decline less than total levels because of changes in protein binding.

  • The period of maximal decline is the first trimester for phenytoin and phenobarbital, & the third trimester for carbamazepine ; valproic acid levels decline throughout pregnancy .

Investigations during pregnancy AED levels

  • 6-10 wks AED levels (free and total), serum folate level

  • 15-16 wks Maternal serum AFP, amniocentesis, AED levels

  • 28 wks AED levels

  • 34-36 wks AED levels, maternal vitamin K

Investigations during pregnancy Ultrasound

  • 18-19 wks A high-level ultrasound predicts a neural-tube defect with an accuracy of more than 95%

  • 22-24 wks Ultrasound for oral clefts and heart anomalies

Management during pregnancy

  • Supplemental folic acid should be ¬†¬†continued during pregnancy

  • If a neural tube defect is identified, for those who continue their pregnancy, a cesarean section should be planned before the onset of labor to avoid trauma to the spine during delivery and potentially to improve functional outcome

  • Women need to obtain adequate sleep because sleep deprivation might increase seizure frequency.

  • Vitamin K, 20 mg a day orally, should be administered for the 2 weeks before delivery to decrease the risk of maternal and neonatal bleeding .

  • Delivery should take place in a clinic with facilities for providing specialized care to epileptic patients and with an associated neonatal intensive care unit.

  • AED administration should be continued during labor.

  • Parenteral medication or additional oral doses may be necessary because of decreased absorption during a prolonged labor.

Risks to the Baby

Since the enzyme-inducing antiepileptic drugs are competitive inhibitors of prothrombin precursors, exposed infants are at increased risk for hemorrhage into body cavities and brain .

  • The risk is greatest on the first day of life

  • Infants may need prolonged coagulation studies

  • Administration of vitamin K reduces the risk of hemorrhage.

  • Current guidelines recommend the oral administration of 2 mg of vitamin K at birth, at the end of the first week, and in the fourth week of life

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