Practice parameter update: Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding: 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, P. B. Pennell, B. S. Koppel, C. A. Hovinga, B. Gidal, K. J. Meador, J. Hopp, T. Y. Ting, W. A. Hauser, D. Thurman, P. W. Kaplan, J. N. Robinson, J. A. French, S. Wiebe, Andrew Wilner, B. Vazquez, L. Holmes, A. Krumholz, R. Finnell, P. O. ShaferC. Le Guen

Research output: Contribution to journalArticle

152 Citations (Scopus)

Abstract

OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid use, prenatal vitamin K use, risk of hemorrhagic disease of the newborn, clinical implications of placental and breast milk transfer of antiepileptic drugs (AEDs), risks of breastfeeding, and change in AED levels during pregnancy. METHODS: A 20-member committee evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and October 2007. RESULTS: Preconceptional folic acid supplementation is possibly effective in preventing major congenital malformations in the newborns of WWE taking AEDs. There is inadequate evidence to determine if the newborns of WWE taking AEDs have a substantially increased risk of hemorrhagic complications. Primidone and levetiracetam probably transfer into breast milk in amounts that may be clinically important. Valproate, phenobarbital, phenytoin, and carbamazepine probably are not transferred into breast milk in clinically important amounts. Pregnancy probably causes an increase in the clearance and a decrease in the concentration of lamotrigine, phenytoin, and to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative. RECOMMENDATIONS: Supplementing women with epilepsy with at least 0.4 mg of folic acid before they become pregnant may be considered (Level C). Monitoring of lamotrigine, carbamazepine, and phenytoin levels during pregnancy should be considered (Level B) and monitoring of levetiracetam and oxcarbazepine (as monohydroxy derivative) levels may be considered (Level C). A paucity of evidence limited the strength of many recommendations.

Original languageEnglish (US)
Pages (from-to)142-149
Number of pages8
JournalNeurology
Volume73
Issue number2
DOIs
StatePublished - Jan 1 2009

Fingerprint

etiracetam
Biomedical Technology Assessment
Vitamin K
Breast Feeding
Folic Acid
Anticonvulsants
Epilepsy
Carbamazepine
Phenytoin
Human Milk
Pregnancy
Vitamin K Deficiency Bleeding
Primidone
Newborn Infant
Committee Membership
Valproic Acid
Therapeutics
Phenobarbital

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): Vitamin K, folic acid, blood levels, and breastfeeding: 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.; Pennell, P. B.; Koppel, B. S.; Hovinga, C. A.; Gidal, B.; Meador, K. J.; Hopp, J.; Ting, T. Y.; Hauser, W. A.; Thurman, D.; Kaplan, P. W.; Robinson, J. N.; French, J. A.; Wiebe, S.; Wilner, Andrew; Vazquez, B.; Holmes, L.; Krumholz, A.; Finnell, R.; Shafer, P. O.; Le Guen, C.

In: Neurology, Vol. 73, No. 2, 01.01.2009, p. 142-149.

Research output: Contribution to journalArticle

Harden, CL, Pennell, PB, Koppel, BS, Hovinga, CA, Gidal, B, Meador, KJ, Hopp, J, Ting, TY, Hauser, WA, Thurman, D, Kaplan, PW, Robinson, JN, French, JA, Wiebe, S, Wilner, A, Vazquez, B, Holmes, L, Krumholz, A, Finnell, R, Shafer, PO & Le Guen, C 2009, 'Practice parameter update: Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding: 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. 142-149. https://doi.org/10.1212/WNL.0b013e3181a6b325
Harden, C. L. ; Pennell, P. B. ; Koppel, B. S. ; Hovinga, C. A. ; Gidal, B. ; Meador, K. J. ; Hopp, J. ; Ting, T. Y. ; Hauser, W. A. ; Thurman, D. ; Kaplan, P. W. ; Robinson, J. N. ; French, J. A. ; Wiebe, S. ; Wilner, Andrew ; Vazquez, B. ; Holmes, L. ; Krumholz, A. ; Finnell, R. ; Shafer, P. O. ; Le Guen, C. / Practice parameter update : Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding: 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. 142-149.
@article{d6dd7ecf1a9f42809bf5a667f7075959,
title = "Practice parameter update: Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society",
abstract = "OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid use, prenatal vitamin K use, risk of hemorrhagic disease of the newborn, clinical implications of placental and breast milk transfer of antiepileptic drugs (AEDs), risks of breastfeeding, and change in AED levels during pregnancy. METHODS: A 20-member committee evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and October 2007. RESULTS: Preconceptional folic acid supplementation is possibly effective in preventing major congenital malformations in the newborns of WWE taking AEDs. There is inadequate evidence to determine if the newborns of WWE taking AEDs have a substantially increased risk of hemorrhagic complications. Primidone and levetiracetam probably transfer into breast milk in amounts that may be clinically important. Valproate, phenobarbital, phenytoin, and carbamazepine probably are not transferred into breast milk in clinically important amounts. Pregnancy probably causes an increase in the clearance and a decrease in the concentration of lamotrigine, phenytoin, and to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative. RECOMMENDATIONS: Supplementing women with epilepsy with at least 0.4 mg of folic acid before they become pregnant may be considered (Level C). Monitoring of lamotrigine, carbamazepine, and phenytoin levels during pregnancy should be considered (Level B) and monitoring of levetiracetam and oxcarbazepine (as monohydroxy derivative) levels may be considered (Level C). A paucity of evidence limited the strength of many recommendations.",
author = "Harden, {C. L.} and Pennell, {P. B.} and Koppel, {B. S.} and Hovinga, {C. A.} and B. Gidal and Meador, {K. J.} and J. Hopp and Ting, {T. Y.} and Hauser, {W. A.} and D. Thurman and Kaplan, {P. W.} and Robinson, {J. N.} and French, {J. A.} and S. Wiebe and Andrew Wilner and B. Vazquez and L. Holmes and A. Krumholz and R. Finnell and Shafer, {P. O.} and {Le Guen}, C.",
year = "2009",
month = "1",
day = "1",
doi = "10.1212/WNL.0b013e3181a6b325",
language = "English (US)",
volume = "73",
pages = "142--149",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Practice parameter update

T2 - Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society

AU - Harden, C. L.

AU - Pennell, P. B.

AU - Koppel, B. S.

AU - Hovinga, C. A.

AU - Gidal, B.

AU - Meador, K. J.

AU - Hopp, J.

AU - Ting, T. Y.

AU - Hauser, W. A.

AU - Thurman, D.

AU - Kaplan, P. W.

AU - Robinson, J. N.

AU - French, J. A.

AU - Wiebe, S.

AU - Wilner, Andrew

AU - Vazquez, B.

AU - Holmes, L.

AU - Krumholz, A.

AU - Finnell, R.

AU - Shafer, P. O.

AU - Le Guen, C.

PY - 2009/1/1

Y1 - 2009/1/1

N2 - OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid use, prenatal vitamin K use, risk of hemorrhagic disease of the newborn, clinical implications of placental and breast milk transfer of antiepileptic drugs (AEDs), risks of breastfeeding, and change in AED levels during pregnancy. METHODS: A 20-member committee evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and October 2007. RESULTS: Preconceptional folic acid supplementation is possibly effective in preventing major congenital malformations in the newborns of WWE taking AEDs. There is inadequate evidence to determine if the newborns of WWE taking AEDs have a substantially increased risk of hemorrhagic complications. Primidone and levetiracetam probably transfer into breast milk in amounts that may be clinically important. Valproate, phenobarbital, phenytoin, and carbamazepine probably are not transferred into breast milk in clinically important amounts. Pregnancy probably causes an increase in the clearance and a decrease in the concentration of lamotrigine, phenytoin, and to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative. RECOMMENDATIONS: Supplementing women with epilepsy with at least 0.4 mg of folic acid before they become pregnant may be considered (Level C). Monitoring of lamotrigine, carbamazepine, and phenytoin levels during pregnancy should be considered (Level B) and monitoring of levetiracetam and oxcarbazepine (as monohydroxy derivative) levels may be considered (Level C). A paucity of evidence limited the strength of many recommendations.

AB - OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid use, prenatal vitamin K use, risk of hemorrhagic disease of the newborn, clinical implications of placental and breast milk transfer of antiepileptic drugs (AEDs), risks of breastfeeding, and change in AED levels during pregnancy. METHODS: A 20-member committee evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and October 2007. RESULTS: Preconceptional folic acid supplementation is possibly effective in preventing major congenital malformations in the newborns of WWE taking AEDs. There is inadequate evidence to determine if the newborns of WWE taking AEDs have a substantially increased risk of hemorrhagic complications. Primidone and levetiracetam probably transfer into breast milk in amounts that may be clinically important. Valproate, phenobarbital, phenytoin, and carbamazepine probably are not transferred into breast milk in clinically important amounts. Pregnancy probably causes an increase in the clearance and a decrease in the concentration of lamotrigine, phenytoin, and to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative. RECOMMENDATIONS: Supplementing women with epilepsy with at least 0.4 mg of folic acid before they become pregnant may be considered (Level C). Monitoring of lamotrigine, carbamazepine, and phenytoin levels during pregnancy should be considered (Level B) and monitoring of levetiracetam and oxcarbazepine (as monohydroxy derivative) levels may be considered (Level C). A paucity of evidence limited the strength of many recommendations.

UR - http://www.scopus.com/inward/record.url?scp=68149094047&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=68149094047&partnerID=8YFLogxK

U2 - 10.1212/WNL.0b013e3181a6b325

DO - 10.1212/WNL.0b013e3181a6b325

M3 - Article

C2 - 19398680

AN - SCOPUS:68149094047

VL - 73

SP - 142

EP - 149

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 2

ER -