UK Wedding News
20/06/2016
The advice has been published at the Royal College of Obstetricians and Gynaecologists World Congress in Birmingham and is the first such guideline on epilepsy in pregnancy.
Around one third of women with epilepsy are of child-bearing age, with an estimated 2,500 babies born to women with the condition each year. While most of these women have healthy pregnancies and babies, having frequent seizures during pregnancy can be extremely harmful to both the mother and her unborn child. The risk of maternal death in increased 10-fold.
With this in mind, it has been suggested that these women should be treated by a specialist healthcare team throughout their pregnancy.
Between 2009 to 2013, 21 women died during pregnancy as a result of epilepsy and the 2014 MBRRACE-UK report highlighted an urgent need to develop national guidance to improve care for pregnant women with epilepsy.
In the majority of cases, the deaths occurred because seizures were poorly controlled. Women were often not given any preconception counselling and were not cared for by an epilepsy nurse or specialist during their pregnancies.
While research has shown that children born to mothers who take anti-epileptic drugs (AEDs) during pregnancy are at an increased risk of physical and developmental problems – such as spina bifida, heart defects and autism – but the guideline stresses that stopping AEDs completely or altering the dose can worsen seizures and pose a risk to both mother and baby.
Women are therefore advised to seek advice from their GP and/or specialist team before conception or as soon as they are aware that they are pregnant. The guideline say that the lowest effective dose of the most appropriate AED should be prescribed.
The guideline also advises women to take a higher dose of folic acid (5mg) to reduce the risk of their baby developing spinal defects. Adequate pain relief and appropriate care and AEDs to minimise the risk of seizures during pregnancy, such as insomnia, stress and dehydration, are also important.
In addition, women at risk of seizures during labour should give birth in consultant-led units with facilities for one-to-one midwifery care and a special care baby unit should extra care be needed.
When it comes to the postnatal period, support for women is also encouraged to ensure that seizure triggers such as sleep deprivation, stress and pain are minimised.
If the AED dose was increased in pregnancy, it should be reviewed within 10 days of delivery to avoid side effects to the mother from exposure to a high dose. The guidelines also recommend women be screened for signs of depression and anxiety in the postnatal period.
Shakila Thangaratinam, Professor of Maternal and Perinatal Health and consultant obstetrician at Barts and The London School of Medicine and Dentistry and lead author of the guideline, explained: "As emphasised in the 2014 MBBRACE-UK report, women with epilepsy require multidisciplinary care throughout their pregnancy, and healthcare professionals need to be aware of the small but significant increase in risks.
"While most women who have epilepsy remain free of seizures throughout their pregnancy, some may have more seizures if they are pregnant. This is usually because they have stopped taking AEDs or are not taking them regularly. Pregnancy itself or tiredness can also increase the number of seizures.
"It is important that these women receive preconception counselling, meet with an epilepsy specialist, and are monitored closely for seizure risk factors. Their adherence to anti-epileptic drugs, seizure type and frequency during the antenatal period should also be closely assessed."
Professor Alan Cameron, RCOG Vice President for Clinical Quality, added: "Care of pregnant women with epilepsy has remained fragmented over recent years.
"This is the first ever national guideline on epilepsy and pregnancy and 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.
"Such a strategy will empower women to make informed decisions about their care during pregnancy with the support from a specialist team."
(JP/LM)
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Calls For Specialist Care For Pregnant Women With Epilepsy
New guidance has called for specialist care for pregnant women with epilepsy.The advice has been published at the Royal College of Obstetricians and Gynaecologists World Congress in Birmingham and is the first such guideline on epilepsy in pregnancy.
Around one third of women with epilepsy are of child-bearing age, with an estimated 2,500 babies born to women with the condition each year. While most of these women have healthy pregnancies and babies, having frequent seizures during pregnancy can be extremely harmful to both the mother and her unborn child. The risk of maternal death in increased 10-fold.
With this in mind, it has been suggested that these women should be treated by a specialist healthcare team throughout their pregnancy.
Between 2009 to 2013, 21 women died during pregnancy as a result of epilepsy and the 2014 MBRRACE-UK report highlighted an urgent need to develop national guidance to improve care for pregnant women with epilepsy.
In the majority of cases, the deaths occurred because seizures were poorly controlled. Women were often not given any preconception counselling and were not cared for by an epilepsy nurse or specialist during their pregnancies.
While research has shown that children born to mothers who take anti-epileptic drugs (AEDs) during pregnancy are at an increased risk of physical and developmental problems – such as spina bifida, heart defects and autism – but the guideline stresses that stopping AEDs completely or altering the dose can worsen seizures and pose a risk to both mother and baby.
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Women are therefore advised to seek advice from their GP and/or specialist team before conception or as soon as they are aware that they are pregnant. The guideline say that the lowest effective dose of the most appropriate AED should be prescribed.
The guideline also advises women to take a higher dose of folic acid (5mg) to reduce the risk of their baby developing spinal defects. Adequate pain relief and appropriate care and AEDs to minimise the risk of seizures during pregnancy, such as insomnia, stress and dehydration, are also important.
In addition, women at risk of seizures during labour should give birth in consultant-led units with facilities for one-to-one midwifery care and a special care baby unit should extra care be needed.
When it comes to the postnatal period, support for women is also encouraged to ensure that seizure triggers such as sleep deprivation, stress and pain are minimised.
If the AED dose was increased in pregnancy, it should be reviewed within 10 days of delivery to avoid side effects to the mother from exposure to a high dose. The guidelines also recommend women be screened for signs of depression and anxiety in the postnatal period.
Shakila Thangaratinam, Professor of Maternal and Perinatal Health and consultant obstetrician at Barts and The London School of Medicine and Dentistry and lead author of the guideline, explained: "As emphasised in the 2014 MBBRACE-UK report, women with epilepsy require multidisciplinary care throughout their pregnancy, and healthcare professionals need to be aware of the small but significant increase in risks.
"While most women who have epilepsy remain free of seizures throughout their pregnancy, some may have more seizures if they are pregnant. This is usually because they have stopped taking AEDs or are not taking them regularly. Pregnancy itself or tiredness can also increase the number of seizures.
"It is important that these women receive preconception counselling, meet with an epilepsy specialist, and are monitored closely for seizure risk factors. Their adherence to anti-epileptic drugs, seizure type and frequency during the antenatal period should also be closely assessed."
Professor Alan Cameron, RCOG Vice President for Clinical Quality, added: "Care of pregnant women with epilepsy has remained fragmented over recent years.
"This is the first ever national guideline on epilepsy and pregnancy and 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.
"Such a strategy will empower women to make informed decisions about their care during pregnancy with the support from a specialist team."
(JP/LM)
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