Management issues for women with epilepsy--focus on pregnancy (an evidence-based review): III. Vitamin K, folic acid, blood levels, and breast-feeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society.
A committee assembled by the American Academy of Neurology (AAN) reassessed the evidence related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid and prenatal vitamin K use and the clinical implications of placental and breast-milk transfer of antiepileptic drugs (AEDs). The committee evaluated the available evidence based on a structured literature review and classification of relevant articles. 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 clinically important amounts. 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 concentrations of lamotrigine, phenytoin, and, to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative (MHD). Supplementing WWE with at least 0.4 mg of folic acid before pregnancy may be considered. Monitoring of lamotrigine, carbamazepine, and phenytoin levels during pregnancy should be considered, and monitoring of levetiracetam and oxcarbazepine (as MHD) levels may be considered. A paucity of evidence limited the strength of many recommendations.
Harden
Cynthia L
CL
University of Miami, Miami, Florida, USA.
Pennell
Page B
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Koppel
Barbara S
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Hovinga
Collin A
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Gidal
Barry
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Meador
Kimford J
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Hopp
Jennifer
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Ting
Tricia Y
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Hauser
W A
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Thurman
David
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Kaplan
Peter W
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Robinson
Julian N
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French
Jacqueline A
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Wiebe
Samuel
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Wilner
Andrew N
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Vazquez
Blanca
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Holmes
Lewis
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Krumholz
Allan
A
Finnell
Richard
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Shafer
Patricia O
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Le Guen
Claire L
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D000927:Anticonvulsants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001942:Breast Feeding; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000517:prevention & control*; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D008895:Milk, Human / Q000378:metabolism; D010920:Placenta / Q000378:metabolism; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D012306:Risk; D014812:Vitamin K / Q000008:administration & dosage*; D006475:Vitamin K Deficiency Bleeding / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
D000927:Anticonvulsants; D014812:Vitamin K; D005492:Folic Acid