Panel: Avoid Epilepsy Drug in Pregnancy
New Guidelines Urge Pregnant Women to Avoid Taking Valproate Because of Risk of Birth Defects
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Epilepsy and Pregnancy continued...
The guidelines were prompted by a thorough review of more than 50 articles published over the last 10 years. They were presented here at the AAN's annual meeting and simultaneously published online in the journal Neurology.
Other recommendations include:
- If possible, women with epilepsy should avoid taking more than one epilepsy drug at a time during pregnancy, as doing so raises the risk of birth defects compared with taking only one medication.
- Pregnant women with epilepsy should have their blood tested regularly. "Pregnancy has been shown to lower the levels of anti-epileptic drugs in the blood, which may put women at risk of seizures. Checking these levels and adjusting the medication doses should help to keep the pregnant woman seizure-free," Harden says.
- Women planning to become pregnant should take at least 400 micrograms of folic acid a day, as supplementation has been shown to be "possibly effective" in preventing major birth defects. That's the same amount of folic acid already recommended by the CDC to prevent neural tube defects, especially spina bifida.
- Smoking during pregnancy may increase substantially the risk of premature contractions and premature labor and delivery during pregnancy.
Epilepsy Drugs and Breastfeeding
The epilepsy drugs primidone (Mysoline) and levetiracetam (Keppra) were detected in breast milk at various levels "that may be clinically important," while valproate, phenobarbital, phenytoin, and carbamazepine (Tegretol) were not, the panel says.
"We didn't find much evidence one way or another that any of the drugs caused adverse effects in babies who were breastfed, but this information can help women and their doctors to make decisions about breastfeeding," Harden says.
Women should not stop taking any drug without consulting their physician, Harden stresses.
She suggests that women with epilepsy have a discussion with their doctor about seizure medications at least six months before becoming pregnant.
Valproate is an "excellent drug," and for some women, it may be the only medication that effectively controls their seizures, Gronseth says. "Women and their doctors have to weigh the potential risk of birth defects against the potential risk of uncontrolled seizures."