Anticonvulsants in Pregnancy: Optimal Care and Risks Management

1. Anticonvulsants in Pregnancy Group B presentation – InderpreetKaur (GPST1)

2. Scenario • A 27 year old lady presents to you as a newly registered patient in your practice. She had recently got married. She has a medical history of epilepsy and has been stable on anti-epileptic medication.

3. Introduction • Pre-conceptual counselling should not be confused with antenatal care • It is the effective advice and guidance which ensures informed choices and the best possible chance of a healthy pregnancy and healthy baby • Often GPs • This can be achieved by providing: • Optimal care of chronic conditions • Lifestyle advice • Supplement advice • Advice to those at increased risk of genetic malformation

4. Primary Care • Although not all pregnancies are planned and many women won’t seek medical advice prior to pregnancy, it is a good opportunity for health promotion if a woman or couple does seek advice • Can raise the topic opportunistically during: • New registration checks • Well woman consultations • Contraceptive advice and reviews • Medication reviews • http://www.fpa.org.uk/sites/default/files/planning-a-pregnancy.pdf

5. Epilepsy • The most common major malformations associated with AEDs include neural tube defects, orofacial defects, congenital heart abnormalities, and hypospadias. • Minor malformations include hypertelorism, epicanthic folds, and digital hypoplasia. • Increases 3 fold with anti-epileptics • In a minority of women with epilepsy there may be an increase in the frequency of seizures (between 15% and 37%). • 1–2% of women with epilepsy will have a tonic-clonic seizure during labour, and a further 1–2% within the following 24 hours.

6. Advice • Reassure the woman that, even on anti-epileptic medication, they are likely to have a healthy pregnancy although the risk of complications during pregnancy and labour is higher. • Refer all women taking anti-epileptic drugs (AEDs) to a specialist for review of epilepsy treatment before the woman becomes pregnant, to discuss the relative risks and benefits of adjusting their medication. • Advise to: • Continue using effective contraception until a full assessment by the specialist has taken place. • Not to stop taking her medication unless otherwise directed by the specialist. • Should be prescribed folic acid 5 mg daily until the twelfth week of pregnancy. • Sodium valporate should be stopped

7. Summary • Opportunistic counselling • Ensure folic acid – higher dose of 5mg until 12th week • Specialist referral • Advise to continue contraception until review • Ensure patient understands risks of AEDs and pregnancy • Advise to continue medication until specialist review