Epilepsy and the outcomes of pregnancy

doi:10.1016/0896-6974(90)90046-2

Journal of Epilepsy

Volume 3, Issue 4, 1990, Pages 193-199

Journal of Epilepsy

https://doi.org/10.1016/0896-6974(90)90046-2 Get rights and content

Abstract

This review article discusses some issues regarding problems facing women with epilepsy who are contemplating pregnancy. Risks to the offspring from seizures and antiepileptic medication are considered, and it is concluded that seizures pose a greater overall risk than do medications used properly. The risk for congenital malformations is greater as more medications are used, and the highest rate of malformation occurs when three or more drugs are used. Although some studies have reported higher rates of mental retardation in infants born to mothers with epilepsy, these conclusions are not supported by well-controlled studies. In general, women with epilepsy have a relative risk ratio for poor outcome of pregnancy of only 1.25 as compared to the general population.

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Cited by (15)

Epilepsy and women's health: Family planning, bone health, menopause, and menstrual-related seizures
2003, Mayo Clinic Proceedings
Citation Excerpt :
The risk of fetal malformation in healthy women in the United States is 2% to 3%.52 For women with epilepsy, the risk is doubled with major malformations occurring in 4% to 6% of women (range, 1%-11.5%).53 In the past, most women with epilepsy were advised not to become pregnant because of the incorrect belief of higher rates of malformation.
Epilepsy uniquely affects more than 1 million American women and girls. Health care providers must be aware of the specific concerns and issues regarding the different effects epilepsy has on male and female patients. Epilepsy and antiepileptic drugs substantially affect women's health in the areas of menstruation, contraception, sexual function, pregnancy, menopause, and bone health. Optimal care of women with epilepsy requires collaboration among neurologists, obstetrician-gynecologists, internists, family practitioners, genetic counselors, and nurse educators. This article reviews some areas of concern for women living with epilepsy.
Congenital neuroblastoma in a boy born to a woman with bipolar disorder treated with carbamazepine during pregnancy
1998, Progress in Neuro-Psychopharmacology and Biological Psychiatry
- 1.
  1. A metastatic neuroblastoma was detected immediately after birth in a boy born to a 26 year old woman with bipolar disorder, who received carbamazepine (400 mg/day) all through her pregnancy. The primary tumor was probably located in the adrenal gland of the right side, and multiple metastatic lesions were detected in the skin.
- 2.
  2. In this report the authors review the literature about the side effects teratogenic and carcinogenic effects of carbamazepine, the epidemiology and evolution of the neuroblastoma, and the current scientific opinion about the pharmacological treatment of the pregnant with mood disorders.
- 3.
  3. A causal relationship between the use of carbamazepine and the neuroblastoma development in the present case can not be established; however, as the carcinogenic and teratogenic effects of the drug have been basically assessed in epileptic women, our aim is to alert the medical community in order to conduct further research in psychiatric patients.
Established antiepileptic drugs
1997, Seizure
Despite the recent entry into the market-place of a range of new pharmacological treatments for epilepsy, most patients still receive the standard antiepileptic drugs. This review considers the clinical place and practical use of these agents. Detailed consideration is given to carbamazepine, phenytoin, sodium valproate, phenobarbital and ethosuximide, with lesser emphasis on primidone, clobazam and clonazepam. Individualization of therapy, polypharmacy, refractory epilepsy, therapeutic drug monitoring, pregnancy, withdrawing treatment, epilepsy prophylaxis and referral to an epilepsy centre are also discussed. The paper concludes with a statement of 12 basic rules in prescribing established antiepileptic drugs.
Epilepsy, pregnancy and parenting—an American perspective
1994, Seizure
Pregnancy for a woman with epilepsy is considered a high risk obstetric condition. However, 90% of women with epilepsy can have safe pregnancies and healthy babies. To achieve this goal several steps must be taken. The pregnancy should be planned and take place at a time when her seizures are well controlled with medications least harmful to the baby. Care during the pregnancy requires a collaborative effort between the neurologist managing her epilepsy and the obstetrician managing the pregnancy. Attention must be given to the effects of pregnancy on seizure control and the effects of the woman's seizures and their treatment on the pregnancy. Education and support assist the woman and other significant people through this process.
After the baby arrives, the woman needs to continue to maintain the best possible seizure control and to plan for the safety of herself and her child if seizures occur. This is a family effort. Attention must also be given to the needs of a child growing up in a home where a parent has seizures.
Epilepsy: Contemporary Perspectives on Evaluation and Treatment
1994, Mayo Clinic Proceedings
To describe the classification of seizures and epilepsies and discuss the medical and surgical treatment options.
The correct classification of types of seizures is necessary for appropriate evaluation and treatment. A neurologic examination can include electroencephalography and magnetic resonance imaging (MRI). MRI has been shown to be diagnostically superior to computed tomography in detecting epileptogenic lesions. With varying degrees of sensitivity and specificity, MRI may identify the underlying pathologic features associated with symptomatic partial epilepsy. Carbamazepine, phenytoin, and valproate sodium are the preferred medical treatments because of their relatively low neurotoxicity. Despite appropriate use of these medications, less than 50% of all patients with epilepsy are rendered free of seizures and experience no antiepileptic drug toxicity. Medically refractory seizures are often physically disabling and may be associated with an alteration in neurocognitive performance and psychosocial debilitation. Treatment options include the antiepileptic drugs felbamate and gabapentin, which have recently been approved in the United States. Surgical resection of epileptic brain tissue remains the most efficacious treatment for patients with intractable partial epilepsy.
Recent developments in neuro-diagnostic studies and treatment strategies have substantially altered the management of patients with epilepsy. Challenging problems include the management of a single seizure, pregnancy and epilepsy, the timing of withdrawal of antiepileptic drug therapy, driving and epilepsy, and the use of alcohol in patients with seizures. The therapeutic goals are to render the patient seizure free and allow the patient to become a productive and participating member of society.
Teratogenesis with carbamazepine
1991, The Lancet

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Epilepsy and the outcomes of pregnancy

Abstract

J Pediatr

Lancet

Lancet

Lancet

Lancet

Lancet

Lancet

J Pediatr

J Pediatr

Am J Obstet Gynecol

Eur J Obstet Gynecol Reprod Biol

J Pediatr

Lancet

Lancet

Lancet

Epilepsy and pregnancy

Aust NZ J Obstet Gynaecol

Congenital malformations

N Engl J Med

Pattern of malformations in the children of women treated with carbamazepine during pregnancy

N Engl J Med

Outcome of pregnancy in women with epilepsy, Norway 1967 to 1978: congenital malformations

Congenital malformations in infants of mothers with diabetes and epilepsy in Western Australia, 1980-1982

Med J Aust

Change of seizure frequency in pregnant epileptic women

J Neurol Neurosurg Psychiatry

Diagnosis of intracranial hemorrhage in utero after a maternal seizure

Obstet Gynecol

Fetal heart rate during a maternal grand mal epileptic seizure

J Perinat Med

Maternal seizure disorder, outcome of pregnancy, and neurologic abnormalities in children

Neurology

Embryopathy during pregnancy caused by taking anticonvulsants

Acta Paedopsychiatr

Are antiepileptic drugs harmful when given during pregnancy?

Ger Med Mon

Epilepsy and pregnancy: a report from the Oxford record linkage study

Br Med J

Congenital malformations

N Engl J Med

Teratogenicity of anticonvulsant drugs I: review of the literature

Am J Med Genet