Epilepsy in Pregnancy Preconception and 1st Folic acid (C) Avoid VPA (A) Trimester Optimize Rx Avoid AED polytherapy (B) During Pregnancy LTG, CBZ, PHT (B); LVT and OXC (C) Consider monitoring: During Breastfeeding transfer into breast milk more than VPA, PB, PHT, and CBZ GBP, LTG, and TPM (C) PRM and LVT (B)
Abbreviations AAN, American Academy of Neurology; AED, antiepileptic drug; CBZ, carbamazepine; ESM, ethosuximide; GBP, gabapentin; LTG, lamotrigine; LVT, levetiracetam; MHD, monohydroxy derivative; MCM, major congenital malformation; OXC, oxcarbazepine; PB, phenobarbital; PHT, phenytoin; PRM, primidone; SGA, small for gestational age; TPM, topiramate; VPA, valproate; WWE, women with epilepsy
Source Reports of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society: 1. Harden CL, Hopp J, Ting TY, et al. Practice parameter update: management issues for women with epilepsy- -focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency. Neurology. 2009 Jul 14;73(2):126-32. Epub 2009 Apr 27. 2. Harden CL, Meador KJ, Pennell PB, et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes. Neurology. 2009 Jul 14;73(2):133-41. Epub 2009 Apr 27. 3.Harden CL, Pennell PB, Koppel BS, 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. Neurology.
2009 Jul 14;73(2):142-9. Epub 2009 Apr 27. Clinical context and AAN Disclosure omitted. See published guidelines for complete text.
Disclaimer
This Guideline attempts to define principles of practice that should produce high-quality patient care. It is applicable to specialists, primary care, and providers at all levels. This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aſter consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool.
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Stop smoking (C)
Favor CBZ (A), PHT (C), and LTG (C) over VPA (MCM risk)
