Epilepsy, pregnancy and breastfeeding: Dr. Page Pennell

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Can women with epilepsy get pregnant, give birth to healthy babies, and breastfeed? What are the myths and misconceptions around epilepsy during pregnancy, and what do physicians and women need to know? Dr. Anca Arbune interviews Dr. Page Pennell about the latest research and knowledge.

Women with epilepsy were once counseled to avoid pregnancy, but epilepsy is no longer a barrier to giving birth. The vast majority of women will have good outcomes.

Fertility issues are not a given in women with epilepsy, though they may arise in men or women taking enzyme-inducing anti-seizure medications.

A long history of taking anti-seizure medication does not affect a woman’s fertility or other outcomes. Only the type of medication taken during pregnancy can exert an influence. Significant reductions in the use of valproate in women of childbearing age mean that most women are taking anti-seizure medications that have lower risks to their babies.

A planned pregnancy with consistent seizure control can lead to safe and healthy outcomes. Certain anti-seizure medications require monitoring during pregnancy, due to changes in physiology and hormone levels.

Breastfeeding is safe and studies show beneficial effects to the infant, similar to those in infants in the general population. 

Research discussed during the episode:

MONEAD (Maternal Outcomes and Neurodevelopmental Effects of Anti-epileptic Drugs) Study

Two-Year-Old Cognitive Outcomes in Children of Pregnant Women With Epilepsy in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs Study (2021) JAMA Neurology (KJ Meador, MJ Cohen, DW Loring, et al.)

Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study (2013) The Lancet Neurology (KJ Meador, GA Baker, N Browning, et al.)

Antiseizure Medication Concentrations During Pregnancy: Results From the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) Study (2022) JAMA Neurology (PB Pennell, A Karanam, KJ Meador, et al.)

Effects of breastfeeding in children of women taking antiepileptic drugs (2010) Neurology (KJ Meador, GA Baker, N Browning, et al.)

Antiepileptic Drug Exposure in Infants of Breastfeeding Mothers With Epilepsy (2019) JAMA Neurology (AK Birnbaum, KJ Meador, A Karanam, et al.)
 
This episode was reported by Dr. Anca Arbune, and edited and produced by Nancy Volkers.

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