Pregnant women with epilepsy need more help to reduce deaths, say top doctors


Health officials must do more to control epilepsy in pregnant women to reduce preventable deaths, leading doctors have said.

The neurological condition can lead to frequent seizures during pregnancy which can be harmful to mother and baby, and the risk of maternal death is increased ten-fold.

Between 2009 and 2013, 21 British women died during pregnancy as a result of epilepsy. In the majority of cases, the deaths occurred because seizures were poorly controlled.

Women were often not given any pre-conception counselling and were not cared for by an epilepsy nurse or specialist during their pregnancies.

Now the first guideline on epilepsy in pregnancy for healthcare professionals and women with the condition has been produced.

The guidance, which is to be published at the Royal College of Obstetricians and Gynaecologists (RCOG) world congress in Birmingham, says that while most women with epilepsy give birth safely, healthcare professionals must give these women "specialist care".

The guidance aims to provide clarity about the condition, one of the most common neurological conditions in pregnancy.

It offers advice on anti-epileptic drugs during pregnancy, supplements and support for new mothers.

Lead author of the guideline, Shakila Thangaratinam, professor of maternal and perinatal health and consultant obstetrician, said: "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 anti-epileptic drugs or are not taking them regularly. Pregnancy itself or tiredness can also increase the number of seizures.

"It is important that these women receive pre-conception 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's 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 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."

Epilepsy affects around 1% of the UK population and around a third of women with the condition are of child-bearing age, with about 2,500 babies being born to women with the condition each year.

Simon Wigglesworth, deputy chief executive at Epilepsy Action, said: "Pregnancy is a life-changing experience for any mum, 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 medications 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."

Louise Silverton, director for midwifery at the Royal College of Midwives (RCM), said: "It is vital we remember that women with epilepsy are classified as high risk during their pregnancy, often they require more monitoring and specialist care during the course of their pregnancy. However, the majority of women with epilepsy will give birth safely."