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Published online before print April 27, 2009, doi:10.1212/WNL.0b013e3181a6b2f8)
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Received December 19, 2008
Accepted March 23, 2009

Practice Parameter update: Management issues for women with epilepsy—focus on pregnancy (an evidence-based review): Obstetrical complications and change in seizure frequency. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society

C. L. Harden MD, J. Hopp MD, T. Y. Ting MD, P. B. Pennell MD, J. A. French MD, W. A. Hauser MD, S. Wiebe MD, G. S. Gronseth MD, D. Thurman MD, MPH, K. J. Meador MD, B. S. Koppel MD, P. W. Kaplan MB, FRCP, J. N. Robinson MD, B. Gidal PharmD, C. A. Hovinga PharmD, A. N. Wilner MD, B. Vazquez MD, L. Holmes MD, A. Krumholz MD, R. Finnell PhD, and C. Le Guen

From the University of Miami (C.L.H.), Miami, FL; University of Maryland (J.H., T.Y.T., A.K.), Baltimore; Emory University (P.B.P., K.J.M.), Atlanta, GA; New York University School of Medicine (J.A.F.), New York; Columbia University (W.A.H.), New York, NY; University of Calgary (S.W.), Alberta, Canada; Kansas University Medical Center (G.S.G.), Kansas City; Centers for Disease Control and Prevention (D.T.), Atlanta, GA; New York Medical College (B.S.K.), New York; Johns Hopkins University (P.W.K.), Baltimore, MD; Harvard Medical School (J.N.R., L.H.), Boston, MA; University of Wisconsin–Madison School of Pharmacy (B.G.); University of Tennessee Health Science Center (C.A.H.), Memphis; private practice (A.N.W.), Newport, RI; New York University (B.V.), New York; Texas A&M University Health Science Center (R.F.); University of Pennsylvania (C.L.), Philadelphia.


Objective: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including the risk of pregnancy complications or other medical problems during pregnancy in WWE compared to other women, change in seizure frequency, the risk of status epilepticus, and the rate of remaining seizure-free during pregnancy.

Methods: A 20-member committee including general neurologists, epileptologists, and doctors in pharmacy evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and February 2008.

Results: For WWE taking antiepileptic drugs, there is probably no substantially increased risk (greater than two times expected) of cesarean delivery or late pregnancy bleeding, and probably no moderately increased risk (greater than 1.5 times expected) of premature contractions or premature labor and delivery. There is possibly a substantially increased risk of premature contractions and premature labor and delivery during pregnancy for WWE who smoke. Seizure freedom for at least 9 months prior to pregnancy is probably associated with a high likelihood (84%–92%) of remaining seizure-free during pregnancy.

Recommendations: Women with epilepsy (WWE) should be counseled that seizure freedom for at least 9 months prior to pregnancy is probably associated with a high rate (84%–92%) of remaining seizure-free during pregnancy (Level B). However, WWE who smoke should be counseled that they possibly have a substantially increased risk of premature contractions and premature labor and delivery during pregnancy (Level C).


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 NeurologyHome page
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, et al.
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
Neurology, July 14, 2009; 73(2): 133 - 141.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
C. L. Harden, P. B. Pennell, B. S. Koppel, C. A. Hovinga, B. Gidal, K. J. Meador, J. Hopp, T. Y. Ting, W. A. Hauser, D. Thurman, et al.
Practice Parameter update: Management issues for women with epilepsy--Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society
Neurology, July 14, 2009; 73(2): 142 - 149.
[Abstract] [Full Text] [PDF]


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