New guidelines aimed at healthcare professionals on care for pregnant women with epilepsy

The Royal College of Obstetricians and Gynaecologists has published new guidelines for healthcare professionals on care for women with epilepsy (WWE) during pregnancy.1

These guidelines highlight that most WWE will have uncomplicated births, and that pregnancies in WWE who do not have a high risk of unprovoked seizures can be managed as low-risk.1

Pregnancies of WWE without a high risk of unprovoked seizures can be managed as low-risk pregnancies.1

The guidelines advise that for WWE planning pregnancy, treatment with sodium valproate and anti-epileptic drug (AED) polytherapy should be minimised after assessment of risks and benefits by an epilepsy specialist.1 Women should also be advised to take folic acid 5 mg/day, prior to and during the first trimester of pregnancy.1

WWE who have an unplanned pregnancy should have quick access to an epilepsy specialist in order to avoid sudden stopping or changing AEDs without discussion with a healthcare professional.1

WWE should receive good antenatal support, including involvement from epilepsy specialists, discussions of AEDs/seizure deterioration during and after pregnancy and while breastfeeding.1

WWE should be given information on the effect of seizures and AED on contraception, pregnancy and breastfeeding, the risks of self-discontinuation of treatment as well as prenatal screening and potential implications.1

For WWE with a risk of seizures during labour, continuous foetal monitoring is recommended.1 The authors also highlight that there are no known contraindications for use of induction agents in WWE.1

WWE who experience an increased AED dose during pregnancy should have their dose reviewed within 10 days after labour to prevent potential postpartum toxicity.1

Reference list

  1. Royal College of Obstetricians Green-top Guideline No. 68. June 2016.

EA/LTG/0004/17 - March 2017