New guidelines call for specialist care for pregnant women with epilepsy

The first guideline on epilepsy in pregnancy has been published at the Royal College of Obstetricians and Gynaecologists (RCOG) World Congress in Birmingham.

It emphasises that for pregnant women, stopping the use of antiepileptic drugs (AEDs) completely or altering the dose can worsen seizures, while posing a serious risk to both mother and baby.

Women are instead advised to seek advice from their GP or specialist team before conception or as soon as they are aware that they are pregnant, with the lowest effective dose of the most appropriate AED recommended for use.

Pregnant patients were also advised to take a higher dose of folic acid to reduce the risk of their baby developing spinal defects, and to give birth in consultant-led units with facilities for one-to-one midwifery care and a special care baby unit, in case extra care is needed.

Finally, the guidance indicated that mothers be well supported in the postnatal period to ensure that seizure triggers such as sleep deprivation, stress and pain are minimised. AED doses should be reviewed within ten days of delivery in cases where dosages were increased during pregnancy.

Professor Alan Cameron, RCOG's vice-president for clinical quality, said: "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."