title: 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.
abstract: 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.
authors.affiliation: University of Miami, Miami, Florida, USA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Harden
authors.forename: Page B
authors.initials: PB
authors.lastname: Pennell
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Koppel
authors.forename: Collin A
authors.initials: CA
authors.lastname: Hovinga
authors.forename: Barry
authors.initials: B
authors.lastname: Gidal
authors.forename: Kimford J
authors.initials: KJ
authors.lastname: Meador
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hopp
authors.forename: Tricia Y
authors.initials: TY
authors.lastname: Ting
authors.forename: W A
authors.initials: WA
authors.lastname: Hauser
authors.forename: David
authors.initials: D
authors.lastname: Thurman
authors.forename: Peter W
authors.initials: PW
authors.lastname: Kaplan
authors.forename: Julian N
authors.initials: JN
authors.lastname: Robinson
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: French
authors.forename: Samuel
authors.initials: S
authors.lastname: Wiebe
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Wilner
authors.forename: Blanca
authors.initials: B
authors.lastname: Vazquez
authors.forename: Lewis
authors.initials: L
authors.lastname: Holmes
authors.forename: Allan
authors.initials: A
authors.lastname: Krumholz
authors.forename: Richard
authors.initials: R
authors.lastname: Finnell
authors.forename: Patricia O
authors.initials: PO
authors.lastname: Shafer
authors.forename: Claire L
authors.initials: CL
authors.lastname: Le Guen
mesh_terms: 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
chemical_list: D000927:Anticonvulsants; D014812:Vitamin K; D005492:Folic Acid