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Borgelt LM, Hart FM, Bainbridge JL. Epilepsy during pregnancy: focus on management strategies. Int J Womens Health. 2016;8:505-517doi: 10.2147/IJWH.S98973.
Borgelt, L. M., Hart, F. M., & Bainbridge, J. L. (2016). Epilepsy during pregnancy: focus on management strategies. International journal of women's health, 8505-517. https://doi.org/10.2147/IJWH.S98973
Borgelt, Laura M, et al. "Epilepsy during pregnancy: focus on management strategies." International journal of women's health vol. 8 (2016): 505-517. doi: https://doi.org/10.2147/IJWH.S98973
Borgelt LM, Hart FM, Bainbridge JL. Epilepsy during pregnancy: focus on management strategies. Int J Womens Health. 2016 Sep 19;8:505-517. doi: 10.2147/IJWH.S98973. eCollection 2016. PMID: 27703396; PMCID: PMC5036546.
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Int J Womens Health. 2016 Sep 19;8:505-517. doi: 10.2147/IJWH.S98973. eCollection 2016.

Epilepsy during pregnancy: focus on management strategies.

International journal of women's health

Laura M Borgelt, Felecia M Hart, Jacquelyn L Bainbridge

Affiliations

  1. Departments of Clinical Pharmacy and Family Medicine.
  2. Departments of Clinical Pharmacy and Neurology, University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.

PMID: 27703396 PMCID: PMC5036546 DOI: 10.2147/IJWH.S98973

Abstract

In the US, more than one million women with epilepsy are of childbearing age and have over 20,000 babies each year. Patients with epilepsy who become pregnant are at risk of complications, including changes in seizure frequency, maternal morbidity and mortality, and congenital anomalies due to antiepileptic drug exposure. Appropriate management of epilepsy during pregnancy may involve frequent monitoring of antiepileptic drug serum concentrations, potential preconception switching of antiepileptic medications, making dose adjustments, minimizing peak drug concentration with more frequent dosing, and avoiding potentially teratogenic medications. Ideally, preconception planning will be done to minimize risks to both the mother and fetus during pregnancy. It is important to recognize benefits and risks of current and emerging therapies, especially with revised pregnancy labeling in prescription drug product information. This review will outline risks for epilepsy during pregnancy, review various recommendations from leading organizations, and provide an evidence-based approach for managing patients with epilepsy before, during, and after pregnancy.

Keywords: anticonvulsants; epilepsy; medication therapy management; teratogens

References

  1. N Engl J Med. 2010 Jun 10;362(23):2185-93 - PubMed
  2. Lancet. 1982 Nov 13;2(8307):1096 - PubMed
  3. Epilepsia. 2005;46 Suppl 9:117-24 - PubMed
  4. Clin Pharmacokinet. 1979 Jan-Feb;4(1):53-62 - PubMed
  5. MMWR Recomm Rep. 2010 Jun 18;59(RR-4):1-86 - PubMed
  6. J Pediatr. 1986 Jun;108(6):997-1004 - PubMed
  7. Br Med J (Clin Res Ed). 1981 Nov 21;283(6303):1405-6 - PubMed
  8. Lancet Neurol. 2011 Jul;10(7):609-17 - PubMed
  9. JAMA Neurol. 2015 Sep;72(9):981-8 - PubMed
  10. Teratology. 1992 Dec;46(6):541-50 - PubMed
  11. Neurology. 2015 Apr 7;84(14):1483-7 - PubMed
  12. Obstet Gynecol. 1980 Nov;56(5):577-82 - PubMed
  13. Acta Neurol Scand. 1988 Sep;78(3):198-205 - PubMed
  14. Arch Neurol. 1994 Mar;51(3):250-3 - PubMed
  15. Am J Hosp Pharm. 1994 Jul 1;51(13):1657-66 - PubMed
  16. Teratology. 1994 Mar;49(3):208-17 - PubMed
  17. Int J Epidemiol. 1978 Sep;7(3):241-7 - PubMed
  18. BMJ. 2010 Dec 02;341:c6581 - PubMed
  19. Brain. 2011 Feb;134(Pt 2):396-404 - PubMed
  20. JAMA. 1981 Jan 2;245(1):36 - PubMed
  21. Epilepsia. 2015 Sep;56(9):1415-24 - PubMed
  22. Obstet Gynecol. 2014 Jan;123(1):21-8 - PubMed
  23. Med J Aust. 1963 Oct 26;2:689-92 - PubMed
  24. J Pediatr. 1981 Jul;99(1):160-2 - PubMed
  25. Neurology. 2008 Sep 2;71(10):706-7 - PubMed
  26. J Neurol Neurosurg Psychiatry. 2006 Feb;77(2):193-8 - PubMed
  27. Drug Metab Dispos. 1991 Nov-Dec;19(6):1116-25 - PubMed
  28. JAMA. 2011 May 18;305(19):1996-2002 - PubMed
  29. Ann Neurol. 1998 Apr;43(4):435-45 - PubMed
  30. Neurology. 2013 Jan 22;80(4):400-5 - PubMed
  31. Prenat Diagn. 1993 Oct;13(10 ):909-18 - PubMed
  32. Lancet. 1977 Sep 17;2(8038):612-3 - PubMed
  33. Am J Health Syst Pharm. 2016 Jun 1;73(11):811-9 - PubMed
  34. J Pediatr. 1977 Jan;90(1):123-6 - PubMed
  35. Sleep Med Rev. 2015 Aug;22:64-77 - PubMed
  36. Epilepsia. 1980 Dec;21(6):663-80 - PubMed
  37. Neurotoxicol Teratol. 1999 Mar-Apr;21(2):157-67 - PubMed
  38. Neurology. 2013 Feb 12;80(7):689 - PubMed
  39. Epilepsia. 2011 Jul;52(7):1365-71 - PubMed
  40. J Clin Neurosci. 2012 Jan;19(1):57-9 - PubMed
  41. Ann Epidemiol. 2011 Nov;21(11):842-50 - PubMed
  42. Teratology. 1992 Jun;45(6):629-36 - PubMed
  43. Neurology. 2008 Jul 22;71(4):272-6 - PubMed
  44. Epilepsia. 1994 Jan-Feb;35(1):122-30 - PubMed
  45. Eur J Pediatr. 1995 Mar;154(3):220-1 - PubMed
  46. Neuropediatrics. 1993 Apr;24(2):88-92 - PubMed
  47. Epilepsia. 2014 Aug;55(8):1229-34 - PubMed
  48. Epilepsia. 1996 Dec;37(12):1242-4 - PubMed
  49. Epilepsia. 2014 Jul;55(7):e72-4 - PubMed
  50. N Engl J Med. 1979 May 31;300(22):1280-1 - PubMed
  51. J Neurol. 2014 Mar;261(3):579-88 - PubMed
  52. Epilepsia. 2007 Jun;48(6):1111-6 - PubMed
  53. Teratology. 1987 Jun;35(3):465-73 - PubMed
  54. Epilepsy Behav. 2007 Sep;11(2):160-78 - PubMed
  55. Br J Obstet Gynaecol. 1986 Oct;93(10):1030-7 - PubMed
  56. MMWR Morb Mortal Wkly Rep. 2011 Jul 8;60(26):878-83 - PubMed
  57. Epilepsia. 1997 Mar;38(3):309-16 - PubMed
  58. Arch Med Res. 1995 Spring;26(1):95-6 - PubMed
  59. Neurology. 2016 May 3;86(18):1716-25 - PubMed
  60. J Clin Psychopharmacol. 2001 Aug;21(4):456-8 - PubMed
  61. Neuropediatrics. 1994 Dec;25(6):334-5 - PubMed
  62. Epilepsia. 2013 Sep;54(9):1621-7 - PubMed
  63. J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1575-83 - PubMed
  64. N Engl J Med. 1998 Apr 16;338(16):1128-37 - PubMed
  65. Eur J Obstet Gynecol Reprod Biol. 1990 Apr;35(1):85-8 - PubMed
  66. BMJ. 2000 Sep 16;321(7262):674-5 - PubMed
  67. Am Fam Physician. 2002 Oct 15;66(8):1489-94 - PubMed
  68. Seizure. 2002 Sep;11(6):349-51 - PubMed
  69. Ann Neurol. 1999 Nov;46(5):739-46 - PubMed
  70. N Engl J Med. 1993 Jun 3;328(22):1641-2 - PubMed
  71. Neurology. 2012 May 22;78(21):1692-9 - PubMed
  72. Eur J Clin Pharmacol. 1992;43(4):381-8 - PubMed
  73. Epilepsia. 2008 Jan;49(1):172-6 - PubMed
  74. Epilepsia. 2004 Nov;45(11):1466 - PubMed
  75. Epilepsia. 1997 Sep;38(9):981-90 - PubMed
  76. J Pediatr. 1976 Aug;89(2):318-9 - PubMed
  77. Am J Health Syst Pharm. 2014 Mar 15;71(6):463-9 - PubMed
  78. Cell. 2009 Oct 16;139(2):380-92 - PubMed
  79. Eur J Clin Pharmacol. 1984;27(1):105-10 - PubMed
  80. Epilepsy Behav. 2013 Nov;29(2):308-15 - PubMed
  81. N Engl J Med. 1973 Nov 15;289(20):1049-52 - PubMed
  82. Expert Opin Drug Metab Toxicol. 2006 Dec;2(6):947-60 - PubMed
  83. Neurology. 2009 Jul 14;73(2):133-41 - PubMed
  84. Epilepsia. 1978 Dec;19(6):535-9 - PubMed
  85. Neurology. 2014 Jul 22;83(4):339-44 - PubMed
  86. Lancet. 2015 Nov 7;386(10006):1845-52 - PubMed
  87. Epilepsy Res. 2005 Jun;65(1-2):117-20 - PubMed
  88. Dev Med Child Neurol. 1994 Apr;36(4):361-9 - PubMed
  89. Acta Paediatr. 1994 Jul;83(7):789-90 - PubMed
  90. Arch Neurol. 2011 Oct;68(10):1275-81 - PubMed
  91. Epilepsy Curr. 2016 May-Jun;16(3):209-11 - PubMed
  92. Eur J Epidemiol. 1989 Mar;5(1):31-6 - PubMed
  93. Neurology. 2005 Jun 14;64(11):1874-8 - PubMed
  94. Continuum (Minneap Minn). 2016 Feb;22(1 Epilepsy):204-26 - PubMed
  95. Lancet Neurol. 2016 Apr;15(4):365-72 - PubMed
  96. Am J Epidemiol. 1979 Apr;109(4):433-9 - PubMed
  97. Seizure. 2015 May;28:32-4 - PubMed
  98. Seizure. 2000 Oct;9(7):464-8 - PubMed
  99. JAMA. 1978 Jul 21;240(3):251-2 - PubMed
  100. N Engl J Med. 1989 Jun 22;320(25):1661-6 - PubMed
  101. Epilepsy Behav. 2013 Oct;29(1):13-8 - PubMed
  102. Nat Rev Neurol. 2014 Nov;10(11):614-6 - PubMed
  103. Seizure. 2015 May;28:46-50 - PubMed
  104. Am J Med Genet. 1988 Jan;29(1):171-85 - PubMed
  105. Fetal Diagn Ther. 1994 May-Jun;9(3):155-8 - PubMed
  106. Neurol Sci. 2015 Jan;36(1):79-83 - PubMed

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