Research published today has stated that pregnant women with epilepsy should receive ‘specialist care’ to lessen the risk of preventable deaths. 

Guidelines from the Royal College of Obstetricians and Gynaecologists World Congress has warned that although most women with the condition deliver their children safely, more still needs to be done by healthcare professionals to control epilepsy during pregnancy. 

 

An MBRRACE-UK report revealed that from 2009 to 2013, 21 women died during pregnancy as a result of epilepsy.

This study highlighted the need to develop national guidance to improve care for pregnant women with epilepsy

In the majority of cases, the deaths occurred because seizures were poorly controlled. Women were often not given any preconception counselling and were not cared for by an epilepsy nurse or specialist during their pregnancies.

Research has shown that children of mothers who take anti-epileptic drugs (AEDs) during pregnancy, in particular sodium valproate, are at an increased risk of problems including spina bifida, heart defects and autism. 

In spite of this the guideline emphasise that stopping AEDs completely or altering the dose can worsen seizures and pose a serious risk to both mother and baby. 

Women are advised to seek advice from their GP and/or specialist team before conception or as soon as they are aware that they are pregnant. The lowest effective dose of the most appropriate AED should be prescribed.

The guideline also advises women to take a higher dose of folic acid (5mg) to reduce the risk of their baby developing spinal defects. 

The report also draws attention to the need for adequate pain relief and appropriate care and AEDs to minimise the risk of seizures during pregnancy, such as insomnia, stress and dehydration.

The study advises that women at risk of seizures during labour should give birth in consultant-led units with facilities for one-to-one midwifery care and a special care baby unit should extra care be needed.

Mothers should also be well supported in the postnatal period to ensure that seizure triggers such as sleep deprivation, stress and pain are minimised, the report urges. 

Shakila Thangaratinam, Professor of Maternal and Perinatal Health and Consultant Obstetrician at Barts and The London School of Medicine and Dentistry and lead author of the guideline, said: “As emphasised in the 2014 MBBRACE-UK report, women with epilepsy require multidisciplinary care throughout their pregnancy, and healthcare professionals need to be aware of the small but significant increase in risks.

“While most women who have epilepsy remain free of seizures throughout their pregnancy, some may have more seizures if they are pregnant. This is usually because they have stopped taking AEDs or are not taking them regularly. Pregnancy itself or tiredness can also increase the number of seizures.

“It is important that these women receive preconception counselling, meet with an epilepsy specialist, and are monitored closely for seizure risk factors. Their adherence to anti-epileptic drugs, seizure type and frequency during the antenatal period should also be closely assessed.”

Professor Alan Cameron, RCOG Vice President for Clinical Quality, said: “Care of pregnant women with epilepsy has remained fragmented over recent years. This is the first ever national guideline on epilepsy and pregnancy and we hope it will support healthcare professionals to ensure that women receive the appropriate counselling before, during and after pregnancy and are aware of the risks to themselves and their baby and the benefits of appropriate treatment. Such a strategy will empower women to make informed decisions about their care during pregnancy with the support from a specialist team.”

The RCOG World Congress is being held from 20-22 June 2016 at the International Conference Centre (ICC) in Birmingham.