Pregnancy planning in women with epilepsy: A single center observational study with focus on epilepsy type

Purpose

To explore various aspects of pregnancy planning in women with epilepsy and to identify factors needing particular attention in the counselling of these patients with focus on epilepsy type.

Methods

285 pregnancies in 192 women were collected from the EURAP registry in Trondheim, Norway. Medical records were reviewed to validate diagnoses and types of epilepsy according to revised ILAE classifications.

Results

Ten women proved to have non-epileptic conditions, leaving 274 pregnancies in 182 patients for inclusion. In 40 %, the epilepsy was focal, in 45 % generalized, including 18 % with JME. In 14 %, the epilepsy type was unknown. Pregnancies were planned in 64 %; 16 % were unintended and 20 % undetermined. Unintended pregnancies occurred in 15 % with focal and in 17 % with generalized epilepsy and in only 10 % of the JME subgroup. Planned pregnancy was associated with both preconception folic acid intake (p < 0.001) and breastfeeding ≥6 months (p = 0.011). Epilepsy of unknown type had the lowest rates of intended pregnancy and folic acid use.

Conclusion

We found no difference in pregnancy planning between focal and generalized epilepsy. Intended pregnancy was strongly associated with both folic acid and breastfeeding. The JME subgroup did not perform worse but rather above average regarding family planning and breastfeeding. The lowest proportion of folic acid intake was found in epilepsy of unknown type in which seizure control is common, and patients may receive less attention from the specialist health service. Appropriate counselling regarding pregnancy should reach out to all fertile women regardless of epilepsy type and seizure control.