The Royal College of Obstetricians and Gynaecologists (RCOG) has today published a new guideline to help healthcare professionals care for women with epilepsy during pregnancy.
The RCOG said that most women with epilepsy give birth safely. However, the organisation believes that healthcare professionals must do more to control the condition in women who are or are trying to become pregnant.
The guideline was released at the RCOG’s World Congress in Birmingham, aiming to provide clear instruction for healthcare professionals and women with epilepsy.
The guideline takes into account recent research on taking some epilepsy medicines, in particular sodium valproate, during pregnancy. The research suggests that some epilepsy medicines could increase the risk of physical and developmental problems in babies.
However, the guideline has also stressed that women should not stop taking their epilepsy medicines or change their dose, as this can worsen seizures and put mother and baby at risk.
The RCOG said it advises women to go to their GP or epilepsy specialist before they become pregnant or as soon as they find out. The new information says that the lowest effective dose of the most appropriate epilepsy medicine should be prescribed.
The guideline encourages women with epilepsy to take a higher dose of folic acid (5mg) to reduce the risk of the baby developing some birth defects. It also informs that the risk of seizures should be minimised during pregnancy with appropriate care to avoid possible triggers like insomnia, stress and dehydration.
The guideline also says that women at risk of seizures during labour should give birth in consultant-led units. Facilities for one-to-one midwifery care and a special care baby unit should be available if extra care is needed.
According to the new information, mothers should also be well supported after the birth to manage seizure triggers such as sleep deprivation, stress and pain.
If the epilepsy medicine dose was increased in pregnancy, it should be reviewed within 10 days of giving birth to avoid side-effects to the mother from a higher medicine dose. The guidelines also recommend that women with epilepsy be screened for signs of depression and anxiety after giving birth.
‘First national guideline’
Professor Alan Cameron, RCOG Vice President for Clinical Quality, said: “Care of pregnant women with epilepsy has remained fragmented over recent years. This is the first ever national guideline on epilepsy and pregnancy. We hope it will support healthcare professionals to ensure that women receive the appropriate counselling before, during and after pregnancy. Such a strategy will empower women to make informed decisions about their care during pregnancy with the support from a specialist team.”
Simon Wigglesworth, deputy chief executive at Epilepsy Action, said: “Epilepsy Action is delighted to see this guidance about epilepsy in pregnancy published by RCOG. Pregnancy is a life-changing experience for any woman, but for women with epilepsy it can be a difficult minefield to navigate. Managing sleepless nights, seizure control and the risks associated with some epilepsy medicines are just three of the many things to think about.
“It is vital that women with epilepsy are given sufficient information and excellent care at all stages of their pregnancy. This ensures that they are able to make informed decisions about all aspects of their health and wellbeing, as well as that of their baby. We hope the new guidelines will enable health professionals to work together and provide the best possible care for women with epilepsy before, during and after pregnancy.”