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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

Authors’ affiliations are listed at the end of the article.
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.

Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116 guidelines{at}aan.com

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).

Abbreviations: AAN = American Academy of Neurology; CI = confidence interval; OR = odds ratio; RR = relative risk; WWE = women with epilepsy.

Supplemental data at www.neurology.org

See pages 133 and 142

e-Pub ahead of print on April 27, 2009, at www.neurology.org.

Published simultaneously in Epilepsia.

The Mission Statements of the Quality Standards Subcommittee (QSS) and Therapeutics and Technology Assessment (TTA) Subcommittee, Conflict of Interest Statement, QSS members, TTA members, AAN classification of evidence, Classification of recommendations (appendices e-1 through e-5), as well as tables e-1 through e-4, are available as supplemental data on the Neurology® Web site at www.neurology.org.

Approved by the Quality Standards Subcommittee November 5, 2008; by the Therapeutics and Technology Assessment Subcommittee November 15, 2008; by the Practice Committee December 18, 2008; and by the AAN Board of Directors March 25, 2009.

Supported by The Milken Family Foundation.

Disclosure: Author disclosures are provided at the end of the article.

Received December 19, 2008. Accepted in final form March 23, 2009.

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