Approved by the Quality Standards Subcommittee on April 15, 2008; by the Therapeutics and Technology Assessment Subcommittee on December 17, 2007; by the Practice Committee on January 10, 2009; and by the AAN Board of Directors on March 25, 2009.
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
Article first published online: 27 APR 2009
Wiley Periodicals, Inc. © 2009 International League Against Epilepsy
Volume 50, Issue 5, pages 1247–1255, May 2009
How to Cite
Harden, C. L., Pennell, P. B., Koppel, B. S., Hovinga, C. A., Gidal, B., Meador, K. J., Hopp, J., Ting, T. Y., Hauser, W. A., Thurman, D., Kaplan, P. W., Robinson, J. N., French, J. A., Wiebe, S., Wilner, A. N., Vazquez, B., Holmes, L., Krumholz, A., Finnell, R., Shafer, P. O. and Le Guen, C. L. (2009), Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): III. Vitamin K, folic acid, blood levels, and breast-feeding. Epilepsia, 50: 1247–1255. doi: 10.1111/j.1528-1167.2009.02130.x
This article is being published jointly/simultaneously by ILAE in Epilepsia and AAN in Neurology.
- Issue published online: 7 MAY 2009
- Article first published online: 27 APR 2009
- Accepted February 24, 2009; Early View publication April 27, 2009.
- Antiepileptic drugs;
- Folic acid;
- Vitamin K
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.