AAN GUIDELINES Bundle

Obstetric/Epilepsy Risks Î There is possibly a substantially increased risk of premature contractions and premature labor and delivery during pregnancy for WWE who smoke (Level C). Î There is probably no moderately increased risk (greater than 1.5x expected) of premature contractions or premature labor and delivery for WWE taking antiepileptic drug (AEDs) (Level B). Î There is probably no substantially increased risk (greater than 2x expected) of cesarean delivery for WWE taking AEDs (Level B). Î However, there is possibly a moderately increased risk (up to 1.5x expected) of cesarean delivery for WWE taking AEDs (Level C). Î There is probably no substantially increased risk (greater than 2x expected) of late pregnancy bleeding for WWE taking AEDs (Level B). Î 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 (Level B). Î There is insufficient evidence to support or refute an increased risk of preeclampsia, pregnancy-related hypertension, spontaneous abortion, a change in seizure frequency, or status epilepticus (Level U). Selecting a Treatment Regimen Î Consider folic acid supplementation before conception in WWE to reduce the risk of major congenital malformations (MCMs) (Level C). Î There is insufficient evidence to support or refute an increased risk of hemorrhagic complications in the newborns of WWE taking AEDs (Level U). Î There is insufficient evidence to support or refute a benefit of prenatal vitamin K supplementation for reducing the risk of hemorrhagic complications in the newborns of WWE (Level U). Î The fact that PB, PRM, PHT, CBZ, LVT, and VPA (Level B) and GBP, LTG, OXC, and TPM (Level C) cross the placenta may be factored into the clinical decision regarding the necessity of AED treatment for a woman with epilepsy. Î VPA, PB, PHT, and CBZ may be considered as not transferring into breast milk to as great an extent as PRM and LVT (Level B) and GBP, LTG, and TPM (Level C). Î Monitoring of LTG, CBZ, and PHT levels during pregnancy should be considered (Level B). Î Monitoring of LVT and OXC (as MHD) levels during pregnancy may be considered (Level C). Î There is insufficient evidence to support or refute a change in PB, VPA, PRM, or ESM levels related to pregnancy (Level U), but this lack of evidence should not discourage monitoring levels of these AEDs during pregnancy.

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