Related Subjects:
|Status Epilepticus (Epilepsy)
|Coma management
|Lorazepam
|Phenytoin
|Levetiracetam
|Epilepsy - General Management
|First Seizure
|Epilepsy in Pregnancy
|Febrile seizures
⚡ Epilepsy in Pregnancy: Management focuses on optimising seizure control while minimising teratogenic risk.
Epilepsy increases maternal mortality, obstetric complications, and fetal risks - so preconception counselling and specialist care are essential.
👉 RCOG 2016 guideline.
📖 About
- ⚠️ Higher risk of maternal mortality in WWE (women with epilepsy).
- ↑ Risk of obstetric haemorrhage and hypertensive disorders.
- Fetal risks: congenital malformations, growth restriction.
🧬 Aetiology / Risks
- Pregnancy increases seizure risk in ~1/3; 2/3 remain stable.
- Valproate: ~11% risk of malformations (vs. 2–3% background).
- Polytherapy ↑ teratogenic risk.
- Triggers: sleep deprivation, stress, missed meds.
📌 Preconception / Planning
- Plan pregnancy with neurologist/epilepsy specialist.
- Start high-dose folic acid 5 mg/day before conception → continue through 1st trimester.
- Switch to lowest effective dose of safest AED (avoid valproate if possible).
- Healthy living: optimise sleep, avoid alcohol, reduce seizure triggers.
💊 AED Exposure & Neurodevelopment
- Valproate → ↑ malformations & cognitive impairment.
- Lamotrigine / carbamazepine → lower risk, relatively safer.
- Levetiracetam & phenytoin → limited long-term data.
🤰 Antenatal Management
- Specialist-led care (joint neurology–obstetric clinics if available).
- Do not stop AEDs suddenly if pregnant unexpectedly.
- Offer detailed anomaly scan (18–20 weeks) → focus on heart, neural tube.
- Serial growth scans if on AEDs.
- Routinely monitor: seizure frequency, AED adherence, mood & mental health.
- Routine AED level monitoring not needed unless clinical concern.
🩺 Intrapartum Care
- Seizure risk in labour is low, but avoid triggers (pain, exhaustion, dehydration).
- Continue AEDs in labour (IV/parenteral if unable to take orally).
- Benzodiazepines = drug of choice for intrapartum seizures.
- Pain relief: TENS, Entonox, regional anaesthesia.
⚠️ Avoid pethidine → can lower seizure threshold; diamorphine safer.
- Continuous fetal monitoring if high risk / post-seizure.
🍼 Postpartum Care
- Seizure risk ↑ in immediate postpartum (sleep deprivation, stress, pain).
- Support mother: minimise triggers.
- Review AED dose within 10 days (esp. if ↑ during pregnancy).
- Neonates exposed in utero → monitor for withdrawal / sedation.
- Breastfeeding encouraged: AED transfer in milk is minimal.
💉 Vitamin K
- Newborns of mothers on enzyme-inducing AEDs → 1 mg IM Vitamin K at birth.
- No clear evidence for routine maternal Vitamin K antenatally.
⚕️ Contraception
- Reliable contraception essential for WWE.
- 💊 AED–contraceptive interactions: enzyme-inducing AEDs (carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, topiramate) reduce efficacy of OCP, patch, implant, ring.
- Preferred: copper IUD, LNG-IUS, medroxyprogesterone injection.
- Emergency contraception: IUD preferred if on enzyme-inducing AEDs.
✨ Safety Advice
- Discuss seizure precautions with baby care (avoid bathing alone, avoid co-sleeping if high risk).
- Encourage partner/family support, especially postpartum.
- Screen for depression/anxiety in perinatal period.
📚 References
