Practice Clinical updates

Epilepsy in pregnancy

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2880 (Published 02 June 2016) Cite this as: BMJ 2016;353:i2880
  1. Michael Owen Kinney, specialist registrar in neurology1,
  2. James Morrow, principal investigator of the UK and Ireland Epilepsy and Pregnancy Register2
  1. 1Department of Neurosciences, Royal Group of Hospitals, Belfast, Northern Ireland
  2. 2Office of the UK and Ireland Epilepsy and Pregnancy Register, Royal Group of Hospitals, Belfast BT12 6BA, Northern Ireland
  1. Correspondence to: J Morrow jjimorrow{at}btinternet.com

What you need to know

  • 96% of babies born to mothers with epilepsy will have no major malformations

  • Offer preconceptual counselling to women with epilepsy at routine follow-up and opportunistically in consultations when appropriate

  • Refer women with epilepsy who wish to become pregnant to specialist services for review of their diagnosis and management plan

  • Advise women with epilepsy who become pregnant unexpectedly to continue with their usual medication and refer them urgently for specialist assessment

  • Advise pregnant women with epilepsy who take antiepileptic medication to take 5 mg folic acid daily for their entire pregnancy

In every 1000 pregnancies, between two and five infants are born to women with epilepsy.1 2 3 For such women, pregnancy can be a time of anxiety over maternal and fetal wellbeing.4 5

Most women with epilepsy will not experience an increase in seizure frequency, and in 96% of pregnancies they will deliver a healthy child.6 However, some women (between 14 and 32 per 100) will experience an increase in seizure frequency,7 which can be harmful for the mother or fetus. There are no randomised controlled trials (RCTs) in women with epilepsy regarding antiepileptic drugs. Evidence comes from observational study and registry data and suggests some antiepileptic drugs are associated with an increased risk of congenital and neurodevelopmental abnormalities.8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Some antiepileptic drugs considered safe to the fetus may be associated with increased risk of seizures and maternal mortality.24 25 This review summarises the current evidence regarding women with epilepsy who are pregnant or planning pregnancy.

Sources and selection criteria

We performed an electronic search of PubMed for relevant English language publications over the past 10 years. The search terms “pregnancy” and “preconceptual” were individually combined with “epilepsy” as search terms. All abstracts were reviewed …

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