Neurologic Disease During Pregnancy
Epilepsy
Women with preexisting epilepsy: seizure frequency increases during pregnancy in 35%, unchanged in 55%, reduced in 10%. Antiepileptic drug (AED) blood concentrations may change: non-protein-bound drug concentrations followed for highly protein-bound AEDs, including carbamazepine, phenytoin valproate.
Older AEDs (benzodiazepines, phenytoin, carbamazepine, phenobarbital, valproate) teratogenic. Major malformations 4% to 6%, compared to 2% to 4% in general population. Information about newer drugs not yet sufficient. Monitor lamotrigine levels (increase during pregnancy). Contact prospective registry for women who become pregnant while taking AEDs.
For all women of childbearing age who take AEDs, prescribe folic acid supplementation to reduce risk of neural tube defects. Vitamin K supplements recommended for last month of gestation to help prevent fetal hemorrhage.
Recommended AED regimen in pregnancy: monotherapy at lowest effective dose. Drug of choice: the one most likely to be effective and tolerated. If family history of neural tube defects, avoid carbamazepine and valproate.
Prenatal diagnostic testing: maternal serum alpha-fetoprotein and ultrasound at 14 to 18 weeks. Combination identifies neural tube defects in 95%.
Pregnant women with new-onset seizures: consider usual causes, also eclampsia. Magnetic resonance (MR) for imaging. Treatment guided by seizure type, etiology.
Preeclampsia and Eclampsia
Mostly young primigravida women.
Preeclampsia: hypertension, proteinuria, edema. Associated with hepatic and coagulation abnormalities, hypoalbuminemia, increased urate levels, hemoconcentration.Related posts:
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