Practice parameter update

Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society

C. L. Harden, K. J. Meador, P. B. Pennell, W. A. Hauser, G. S. Gronseth, J. A. French, S. Wiebe, D. Thurman, B. S. Koppel, P. W. Kaplan, J. N. Robinson, J. Hopp, T. Y. Ting, B. Gidal, C. A. Hovinga, Andrew Wilner, B. Vazquez, L. Holmes, A. Krumholz, R. Finnell & 2 others D. Hirtz, C. Le Guen

Research output: Contribution to journalArticle

225 Citations (Scopus)

Abstract

OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy. METHODS: Systematic review of relevant articles published between January 1985 and June 2007. RESULTS: It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine and possible compared to phenytoin or lamotrigine. Compared to untreated WWE, it is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. It is probable that antiepileptic drug (AED) polytherapy as compared to monotherapy regimens contributes to the development of MCMs and to reduced cognitive outcomes. For monotherapy, intrauterine exposure to VPA probably reduces cognitive outcomes. Further, monotherapy exposure to phenytoin or phenobarbital possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7. RECOMMENDATIONS: If possible, avoidance of valproate (VPA) and antiepileptic drug (AED) polytherapy during the first trimester of pregnancy should be considered to decrease the risk of major congenital malformations (Level B). If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered to prevent reduced cognitive outcomes (Level B). If possible, avoidance of phenytoin and phenobarbital during pregnancy may be considered to prevent reduced cognitive outcomes (Level C). Pregnancy risk stratification should reflect that the offspring of women with epilepsy taking AEDs are probably at increased risk for being small for gestational age (Level B) and possibly at increased risk of 1-minute Apgar scores of <7 (Level C).

Original languageEnglish (US)
Pages (from-to)133-141
Number of pages9
JournalNeurology
Volume73
Issue number2
DOIs
StatePublished - Jan 1 2009

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Teratogenesis
Biomedical Technology Assessment
Valproic Acid
Epilepsy
Pregnancy
Phenytoin
Combination Drug Therapy
Anticonvulsants
Apgar Score
First Pregnancy Trimester
Phenobarbital
Therapeutics
Gestational Age
Carbamazepine
Newborn Infant

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Practice parameter update : Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. / Harden, C. L.; Meador, K. J.; Pennell, P. B.; Hauser, W. A.; Gronseth, G. S.; French, J. A.; Wiebe, S.; Thurman, D.; Koppel, B. S.; Kaplan, P. W.; Robinson, J. N.; Hopp, J.; Ting, T. Y.; Gidal, B.; Hovinga, C. A.; Wilner, Andrew; Vazquez, B.; Holmes, L.; Krumholz, A.; Finnell, R.; Hirtz, D.; Le Guen, C.

In: Neurology, Vol. 73, No. 2, 01.01.2009, p. 133-141.

Research output: Contribution to journalArticle

Harden, CL, Meador, KJ, Pennell, PB, Hauser, WA, Gronseth, GS, French, JA, Wiebe, S, Thurman, D, Koppel, BS, Kaplan, PW, Robinson, JN, Hopp, J, Ting, TY, Gidal, B, Hovinga, CA, Wilner, A, Vazquez, B, Holmes, L, Krumholz, A, Finnell, R, Hirtz, D & Le Guen, C 2009, 'Practice parameter update: Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society', Neurology, vol. 73, no. 2, pp. 133-141. https://doi.org/10.1212/WNL.0b013e3181a6b312
Harden, C. L. ; Meador, K. J. ; Pennell, P. B. ; Hauser, W. A. ; Gronseth, G. S. ; French, J. A. ; Wiebe, S. ; Thurman, D. ; Koppel, B. S. ; Kaplan, P. W. ; Robinson, J. N. ; Hopp, J. ; Ting, T. Y. ; Gidal, B. ; Hovinga, C. A. ; Wilner, Andrew ; Vazquez, B. ; Holmes, L. ; Krumholz, A. ; Finnell, R. ; Hirtz, D. ; Le Guen, C. / Practice parameter update : Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. In: Neurology. 2009 ; Vol. 73, No. 2. pp. 133-141.
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abstract = "OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy. METHODS: Systematic review of relevant articles published between January 1985 and June 2007. RESULTS: It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine and possible compared to phenytoin or lamotrigine. Compared to untreated WWE, it is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. It is probable that antiepileptic drug (AED) polytherapy as compared to monotherapy regimens contributes to the development of MCMs and to reduced cognitive outcomes. For monotherapy, intrauterine exposure to VPA probably reduces cognitive outcomes. Further, monotherapy exposure to phenytoin or phenobarbital possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7. RECOMMENDATIONS: If possible, avoidance of valproate (VPA) and antiepileptic drug (AED) polytherapy during the first trimester of pregnancy should be considered to decrease the risk of major congenital malformations (Level B). If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered to prevent reduced cognitive outcomes (Level B). If possible, avoidance of phenytoin and phenobarbital during pregnancy may be considered to prevent reduced cognitive outcomes (Level C). Pregnancy risk stratification should reflect that the offspring of women with epilepsy taking AEDs are probably at increased risk for being small for gestational age (Level B) and possibly at increased risk of 1-minute Apgar scores of <7 (Level C).",
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AU - Harden, C. L.

AU - Meador, K. J.

AU - Pennell, P. B.

AU - Hauser, W. A.

AU - Gronseth, G. S.

AU - French, J. A.

AU - Wiebe, S.

AU - Thurman, D.

AU - Koppel, B. S.

AU - Kaplan, P. W.

AU - Robinson, J. N.

AU - Hopp, J.

AU - Ting, T. Y.

AU - Gidal, B.

AU - Hovinga, C. A.

AU - Wilner, Andrew

AU - Vazquez, B.

AU - Holmes, L.

AU - Krumholz, A.

AU - Finnell, R.

AU - Hirtz, D.

AU - Le Guen, C.

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N2 - OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy. METHODS: Systematic review of relevant articles published between January 1985 and June 2007. RESULTS: It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine and possible compared to phenytoin or lamotrigine. Compared to untreated WWE, it is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. It is probable that antiepileptic drug (AED) polytherapy as compared to monotherapy regimens contributes to the development of MCMs and to reduced cognitive outcomes. For monotherapy, intrauterine exposure to VPA probably reduces cognitive outcomes. Further, monotherapy exposure to phenytoin or phenobarbital possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7. RECOMMENDATIONS: If possible, avoidance of valproate (VPA) and antiepileptic drug (AED) polytherapy during the first trimester of pregnancy should be considered to decrease the risk of major congenital malformations (Level B). If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered to prevent reduced cognitive outcomes (Level B). If possible, avoidance of phenytoin and phenobarbital during pregnancy may be considered to prevent reduced cognitive outcomes (Level C). Pregnancy risk stratification should reflect that the offspring of women with epilepsy taking AEDs are probably at increased risk for being small for gestational age (Level B) and possibly at increased risk of 1-minute Apgar scores of <7 (Level C).

AB - OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy. METHODS: Systematic review of relevant articles published between January 1985 and June 2007. RESULTS: It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine and possible compared to phenytoin or lamotrigine. Compared to untreated WWE, it is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. It is probable that antiepileptic drug (AED) polytherapy as compared to monotherapy regimens contributes to the development of MCMs and to reduced cognitive outcomes. For monotherapy, intrauterine exposure to VPA probably reduces cognitive outcomes. Further, monotherapy exposure to phenytoin or phenobarbital possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7. RECOMMENDATIONS: If possible, avoidance of valproate (VPA) and antiepileptic drug (AED) polytherapy during the first trimester of pregnancy should be considered to decrease the risk of major congenital malformations (Level B). If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered to prevent reduced cognitive outcomes (Level B). If possible, avoidance of phenytoin and phenobarbital during pregnancy may be considered to prevent reduced cognitive outcomes (Level C). Pregnancy risk stratification should reflect that the offspring of women with epilepsy taking AEDs are probably at increased risk for being small for gestational age (Level B) and possibly at increased risk of 1-minute Apgar scores of <7 (Level C).

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