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Contraception, pregnancy and lactation in women with epilepsy.
Baillieres Clin Neurol 1996; 5(4):887-908BC

Abstract

Despite all of our advances women with epilepsy face obstacles when it comes to pregnancy and childbearing. Many of these obstacles are social, based on incorrect and inappropriate attitudes of the public towards persons with epilepsy. Unfortunately many of the uninformed public are health care providers. We must continue to educate not only our patients but our colleagues so that women with epilepsy will cease to face discriminatory behaviour. Most women with epilepsy can conceive and bear healthy children. They have higher probabilities of infertility but this is often amenable to treatment. Complications of pregnancy are higher and revolve primarily around the increased risk of maternal seizures. Careful monitoring of the clinical condition of the patient and her free anticonvulsant levels will obviate much of this difficulty. Maternal seizures themselves can pose hazards for women with epilepsy and their offspring and generalized convulsive seizures are clearly to be avoided. Adverse pregnancy outcomes tend to be seen more often in particular: congenital malformations 4-6%; dysmorphic features < 10%; neonatal haemorrhage < 7%; fetal death and neonatal and infant mortality a two to threefold increase over the general population; and an uncertain risk of developmental delay particularly in the area of language acquisition. Of the potential variables of interest: anticonvulsants, maternal seizures during gestation, and the genetics of maternal epilepsy, it is at present unclear which is the most important in determining a good pregnancy outcome. Current research suggests that anticonvulsant drugs are probably responsible for the increased risk of malformations. Malformations are, however, only one of the adverse outcomes of concern. Risks can be reduced by ensuring good seizure control; monotherapy: preconceptual use of multivitamins with folate. The plethora of new anticonvulsants offers us new opportunities for improving the function and control of persons with epilepsy. Unfortunately we are uncertain how hazardous the newer anticonvulsant drugs are in pregnancy. Felbamate, gabapentin, lamotrigine, vigabatrine, and topiramate have all been recently introduced. The number of exposed women is so small that no pattern or estimates of risk can be determined at this time. Careful monitoring as is being performed by the Lamotrigine and North American Epilepsy and Pregnancy Registries will hopefully provide the necessary safety information in the near future. All of the risks aside, the majority of women with epilepsy can and will have healthy children.

Authors+Show Affiliations

North Pacific Epilepsy Research, Portland, OR 97210, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

9068887

Citation

Yerby, M S.. "Contraception, Pregnancy and Lactation in Women With Epilepsy." Bailliere's Clinical Neurology, vol. 5, no. 4, 1996, pp. 887-908.
Yerby MS. Contraception, pregnancy and lactation in women with epilepsy. Baillieres Clin Neurol. 1996;5(4):887-908.
Yerby, M. S. (1996). Contraception, pregnancy and lactation in women with epilepsy. Bailliere's Clinical Neurology, 5(4), pp. 887-908.
Yerby MS. Contraception, Pregnancy and Lactation in Women With Epilepsy. Baillieres Clin Neurol. 1996;5(4):887-908. PubMed PMID: 9068887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contraception, pregnancy and lactation in women with epilepsy. A1 - Yerby,M S, PY - 1996/12/1/pubmed PY - 1996/12/1/medline PY - 1996/12/1/entrez KW - Biology KW - Chronic Diseases KW - Congenital Abnormalities KW - Contraception KW - Diseases KW - Drugs KW - Family Planning KW - Fetus KW - Lactation KW - Literature Review KW - Maternal Physiology KW - Neonatal Diseases And Abnormalities KW - Neurologic Effects KW - Physiology KW - Pregnancy KW - Pregnancy Complications KW - Reproduction KW - Treatment SP - 887 EP - 908 JF - Bailliere's clinical neurology JO - Baillieres Clin Neurol VL - 5 IS - 4 N2 - Despite all of our advances women with epilepsy face obstacles when it comes to pregnancy and childbearing. Many of these obstacles are social, based on incorrect and inappropriate attitudes of the public towards persons with epilepsy. Unfortunately many of the uninformed public are health care providers. We must continue to educate not only our patients but our colleagues so that women with epilepsy will cease to face discriminatory behaviour. Most women with epilepsy can conceive and bear healthy children. They have higher probabilities of infertility but this is often amenable to treatment. Complications of pregnancy are higher and revolve primarily around the increased risk of maternal seizures. Careful monitoring of the clinical condition of the patient and her free anticonvulsant levels will obviate much of this difficulty. Maternal seizures themselves can pose hazards for women with epilepsy and their offspring and generalized convulsive seizures are clearly to be avoided. Adverse pregnancy outcomes tend to be seen more often in particular: congenital malformations 4-6%; dysmorphic features < 10%; neonatal haemorrhage < 7%; fetal death and neonatal and infant mortality a two to threefold increase over the general population; and an uncertain risk of developmental delay particularly in the area of language acquisition. Of the potential variables of interest: anticonvulsants, maternal seizures during gestation, and the genetics of maternal epilepsy, it is at present unclear which is the most important in determining a good pregnancy outcome. Current research suggests that anticonvulsant drugs are probably responsible for the increased risk of malformations. Malformations are, however, only one of the adverse outcomes of concern. Risks can be reduced by ensuring good seizure control; monotherapy: preconceptual use of multivitamins with folate. The plethora of new anticonvulsants offers us new opportunities for improving the function and control of persons with epilepsy. Unfortunately we are uncertain how hazardous the newer anticonvulsant drugs are in pregnancy. Felbamate, gabapentin, lamotrigine, vigabatrine, and topiramate have all been recently introduced. The number of exposed women is so small that no pattern or estimates of risk can be determined at this time. Careful monitoring as is being performed by the Lamotrigine and North American Epilepsy and Pregnancy Registries will hopefully provide the necessary safety information in the near future. All of the risks aside, the majority of women with epilepsy can and will have healthy children. SN - 0961-0421 UR - https://www.unboundmedicine.com/medline/citation/9068887/Contraception_pregnancy_and_lactation_in_women_with_epilepsy_ L2 - http://www.diseaseinfosearch.org/result/2593 DB - PRIME DP - Unbound Medicine ER -