Pregnancy Safe With Epilepsy, But Valproate Should Be Avoided, New Guidelines State

The guidelines are published in the April 27, 2009, print issue of Neurology®, the medical journal of the American Academy of Neurology, and will be presented April 27, 2009, at the Academy's Annual Meeting in Seattle.

The guidelines recommend women with epilepsy avoid taking the drug valproate during pregnancy.

"Good evidence shows that valproate is linked to an increased risk for fetal malformations and decreased thinking skills in children, whether used by itself or with other medications," said lead guideline author Cynthia Harden, MD, Director of the Epilepsy Division at the University of Miami's Miller School of Medicine and member of the American Academy of Neurology.

The guidelines also suggest, if possible, women with epilepsy should not take more than one epilepsy drug at a time during pregnancy since taking more than one seizure drug has also been found to increase the risk of birth defects compared to taking only one medication.

"Overall, what we found should be very reassuring to every woman with epilepsy planning to become pregnant," said Harden. "These guidelines show that women with epilepsy are not at a substantially increased risk of having a Cesarean section, late pregnancy bleeding, or premature contractions or premature labor and delivery. Also, if a woman is seizure free nine months before she becomes pregnant, it's likely that she will not have any seizures during the pregnancy."

However, Harden says pregnant women with epilepsy should consider having their blood tested regularly. "Levels of seizure medications in the blood tend to drop during pregnancy, so checking these levels and adjusting the medication doses should help to keep the levels in the effective range and the pregnant woman seizure free."

The guidelines also state that physicians of women with epilepsy should consider avoiding the epilepsy drugs phenytoin and phenobarbital in order to prevent the possibility of decreased thinking skills in children. In addition, the guidelines recommend women with epilepsy be warned that smoking may increase substantially the risk of premature contractions and premature labor and delivery during pregnancy.

It is estimated that about half a million women with epilepsy in the United States are of childbearing age and that three to five out of every 1,000 births are to women with epilepsy. The majority of people with epilepsy have well-controlled seizures, are otherwise healthy, and expect to participate fully in life experiences, including pregnancy.

To develop the guidelines, the authors reviewed all scientific studies available on the topic. The guidelines were developed in collaboration with the American Epilepsy Society and will also appear be published in the April 27 online issue of the journal Epilepsia.

The development of the guidelines was supported in part by the Milken Family Foundation.

"For too long, women living with epilepsy have feared the added risk of premature birth and other consequences of both their epilepsy and their medications," said Howard R. Soule, PhD, chief science officer for the Milken Family Foundation. "The results of this project will help relieve the worries of these women and their families."