title: Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: 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 the risk of pregnancy complications or other medical problems during pregnancy in WWE compared to other women, change in seizure frequency, the risk of status epilepticus, and the rate of remaining seizure-free during pregnancy.
  
  
  METHODS
  A 20-member committee including general neurologists, epileptologists, and doctors in pharmacy evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and February 2008.
  
  
  RESULTS
  For WWE taking antiepileptic drugs, there is probably no substantially increased risk (greater than two times expected) of cesarean delivery or late pregnancy bleeding, and probably no moderately increased risk (greater than 1.5 times expected) of premature contractions or premature labor and delivery. There is possibly a substantially increased risk of premature contractions and premature labor and delivery during pregnancy for WWE who smoke. Seizure freedom for at least 9 months prior to pregnancy is probably associated with a high likelihood (84%-92%) of remaining seizure-free during pregnancy.
  
  
  CONCLUSIONS
  Women with epilepsy (WWE) should be counseled that seizure freedom for at least 9 months prior to pregnancy is probably associated with a high rate (84%-92%) of remaining seizure-free during pregnancy (Level B). However, WWE who smoke should be counseled that they possibly have a substantially increased risk of premature contractions and premature labor and delivery during pregnancy (Level C).
authors.affiliation: University of Miami, Miami, FL, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Harden
authors.forename: J
authors.initials: J
authors.lastname: Hopp
authors.forename: T Y
authors.initials: TY
authors.lastname: Ting
authors.forename: P B
authors.initials: PB
authors.lastname: Pennell
authors.forename: J A
authors.initials: JA
authors.lastname: French
authors.forename: W A
authors.initials: WA
authors.lastname: Hauser
authors.forename: S
authors.initials: S
authors.lastname: Wiebe
authors.forename: G S
authors.initials: GS
authors.lastname: Gronseth
authors.forename: D
authors.initials: D
authors.lastname: Thurman
authors.forename: K J
authors.initials: KJ
authors.lastname: Meador
authors.forename: B S
authors.initials: BS
authors.lastname: Koppel
authors.forename: P W
authors.initials: PW
authors.lastname: Kaplan
authors.forename: J N
authors.initials: JN
authors.lastname: Robinson
authors.forename: B
authors.initials: B
authors.lastname: Gidal
authors.forename: C A
authors.initials: CA
authors.lastname: Hovinga
authors.forename: A N
authors.initials: AN
authors.lastname: Wilner
authors.forename: B
authors.initials: B
authors.lastname: Vazquez
authors.forename: L
authors.initials: L
authors.lastname: Holmes
authors.forename: A
authors.initials: A
authors.lastname: Krumholz
authors.forename: R
authors.initials: R
authors.lastname: Finnell
authors.forename: C
authors.initials: C
authors.lastname: Le Guen
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000927:Anticonvulsants / Q000627:therapeutic use; D002585:Cesarean Section; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000453:epidemiology*; D012008:Recurrence; D012306:Risk; D012907:Smoking / Q000453:epidemiology; D013226:Status Epilepticus / Q000188:drug therapy / Q000453:epidemiology; D014592:Uterine Hemorrhage / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants