PMM.62 How are antiepileptic drugs managed in pregnant women with epilepsy in Nottingham?

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Abstract

Background

Epilepsy is a common neurological disease in pregnancy. There is an increased risk of teratogenesis in pregnant women taking antiepileptic drugs (AEDs). Stopping medication can result in seizures, potentially increasing maternal and fetal morbidity. Clearance of newer drugs (lamotrigine and levetiracetam) increases in pregnancy but routinely measuring drug serum concentrations is not recommended nationally.1 Local protocol is to measure AED levels and adjust AED doses accordingly. This audit looked at the management of pregnant women with epilepsy (WWE) taking AEDs.

Methods

This was a retrospective audit of 45 patients seen at the joint antenatal clinic from October 2011 to 2013. Data was collected on baseline demographics, information given on AEDs, AED levels in pregnancy and pregnancy outcomes.

Results

35.6% of pregnant WWE received preconception counselling. 64.4% of patients were given 5mg/day folic acid. Pre-conception drug levels were taken in 33.3% of those taking lamotrigine and 22.2% taking levetiracetam. Taking regular drug levels and increasing doses was more common in lamotrigine than levetiracetam.

Conclusions

Improving the number of women who receive preconception counselling and folic acid before pregnancy will need a multidisciplinary approach focussing on education in adolescence. If AED levels are to be useful in pregnancy, levels should be measured as soon as stable AED regimes are established. In order to prevent sub-therapeutic levels being undetected, a minimum of four levels should be measured during pregnancy, with approximately four weeks between each level being obtained. This audit should be repeated in 2–3 years to assess changes in care.

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