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Management issues for women with epilepsy—Focus on pregnancy (an evidence‐based review): III. Vitamin K, folic acid, blood levels, and breast‐feeding
Author(s) -
Harden Cynthia L.,
Pennell Page B.,
Koppel Barbara S.,
Hovinga Collin A.,
Gidal Barry,
Meador Kimford J.,
Hopp Jennifer,
Ting Tricia Y.,
Hauser W. A.,
Thurman David,
Kaplan Peter W.,
Robinson Julian N.,
French Jacqueline A.,
Wiebe Samuel,
Wilner Andrew N.,
Vazquez Blanca,
Holmes Lewis,
Krumholz Allan,
Finnell Richard,
Shafer Patricia O.,
Le Guen Claire L.
Publication year - 2009
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2009.02130.x
Subject(s) - carbamazepine , medicine , levetiracetam , lamotrigine , primidone , oxcarbazepine , phenytoin , pregnancy , epilepsy , breast feeding , breast milk , pediatrics , obstetrics , physiology , psychiatry , biochemistry , chemistry , biology , genetics
Summary 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.