Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6bf8c574d5-w79xw Total loading time: 0 Render date: 2025-02-21T10:49:05.225Z Has data issue: false hasContentIssue false

Chapter 18 - Management of the Neonate

Clinical Examination and Surveillance

Published online by Cambridge University Press:  19 December 2024

By
Carlos I. Salazar ,
Eugene Ng  and
Cecil D. Hahn
Edited by
Esther Bui  and
P. Emanuela Voinescu
Esther Bui
Affiliation:
Toronto Western Hospital
P. Emanuela Voinescu
Affiliation:
Brigham & Women's Hospital, Boston, MA
Get access

Summary

Epilepsy requiring ongoing medical treatment is the most common neurologic disorder in pregnancy [1]. Data from a number of population-based studies estimate that maternal epilepsy is present in 0.3–1% of all pregnancies [2–7], the vast majority representing women with preexisting epilepsy, and a minority (2–10%) representing women with new-onset epilepsy during pregnancy [8, 9]. The incidence of antiseizure medication (ASM) use is estimated at 0.3–0.4% of all pregnancies, which includes those who are maintained on ASMs for neuropsychiatric disorders such as bipolar and schizoaffective disorders, a practice that has become more common in the past two decades [3–5, 10, 11].

Type
Chapter
Information
Women with Epilepsy
A Practical Management Handbook
 , pp. 293 - 305
Publisher: Cambridge University Press
Print publication year: 2025

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Pennell, PB. Pregnancy in women who have epilepsy. Neurologic Clinics. 2004;22:799–820.CrossRefGoogle ScholarPubMed
Olafsson, E, Hallgrimsson, JT, Hauser, WA, Ludvigsson, P, Gudmundsson, G. Pregnancies of women with epilepsy: A population-based study in Iceland. Epilepsia. 1998;39(8):887–92.CrossRefGoogle ScholarPubMed
Veiby, G, Daltveit, AK, Engelsen, BA, Gilhus, NE. Pregnancy, delivery, and outcome for the child in maternal epilepsy. Epilepsia. 2009;50(9):2130–9.CrossRefGoogle ScholarPubMed
Borthen, I, Eide, MG, Veiby, G, Daltveit, AK, Gilhus, NE. Complications during pregnancy in women with epilepsy: Population-based cohort study. BJOG. 2009;116(13):1736–42.CrossRefGoogle ScholarPubMed
Brosh, K, Matok, I, Sheine, E, et al. Teratogenic determinants of first-trimester exposure to antiepileptic medications. J Popul Ther Clin Pharmacol. 2011;18(1):89–98.Google ScholarPubMed
Royal College of Obstetricians & Gynaecologists. Epilepsy in pregnancy: Green-top guideline no. 68. London: Royal College of Obstetricians & Gynaecologists; 2016. www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg68_epilepsy.pdf.Google Scholar
Bansal, R, Jain, G, Kharbanda, PS, Goyal, MK, Suri, V. Maternal and neonatal complications during pregnancy in women with epilepsy. Int J Epilepsy. 2016;3(2):80–5.Google Scholar
Li, W, Hao, N, Xiao, Y, Zhou, D. Clinical characteristics and pregnancy outcomes of new onset epilepsy during pregnancy. Medicine (Baltimore). 2019;98(27):1–5.Google ScholarPubMed
Johnson, EL, Burke, AE, Wang, A, Pennell, PB. Unintended pregnancy, prenatal care, newborn outcomes, and breastfeeding in women with epilepsy. Neurology. 2018;91(11):e1031–9.CrossRefGoogle ScholarPubMed
Pennell, PB. Use of antiepileptic drugs during pregnancy: Evolving concepts. Neurotherapeutics. 2016;13(4):811–20. http://dx.doi.org/10.1007/s13311-016-0464-0.CrossRefGoogle ScholarPubMed
Giménez, A, Pacchiarotti, I, Gil, J, et al. Adverse outcomes during pregnancy and major congenital malformations in infants of patients with bipolar and schizoaffective disorders treated with antiepileptic drugs: A systematic review. Psychiatr Pol. 2019;53(2):223–44.CrossRefGoogle ScholarPubMed
Razaz, N, Tomson, T, Wikström, AK, Cnattingius, S. Association between pregnancy and perinatal outcomes among women with epilepsy. JAMA Neurol. 2017;74(8):983–91.CrossRefGoogle ScholarPubMed
Meador, KJ, Pennell, PB, May, RC, et al. Fetal loss and malformations in the MONEAD study of pregnant women with epilepsy. Neurology. 2020;94(14):E1502–11.CrossRefGoogle ScholarPubMed
Tomson, T, Battino, D, Bonizzoni, E, et al. Dose-dependent risk of malformations with antiepileptic drugs: An analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol. 2011;10(7):609–17. http://dx.doi.org/10.1016/S1474-4422(11)70107-7.CrossRefGoogle ScholarPubMed
Iqbal, MM, Gundlapalli, SP, Ryan, WG, Ryals, T, Passman, TE. Effects of antimanic mood-stabilizing drugs on fetuses, neonates, and nursing infants. South Med J. 2001;94(3):304–22.CrossRefGoogle ScholarPubMed
Meador, KJ, Baker, GA, Browning, N, et al. Foetal antiepileptic drug exposure and verbal versus non-verbal abilities at three years of age. Brain. 2011;134(2):396–404.CrossRefGoogle ScholarPubMed
Bromley, R, Weston, J, Adab, N, et al. Treatment for epilepsy in pregnancy: Neurodevelopmental outcomes in the child. Cochrane Database Syst Rev. 2014;2014(10):CD010236.Google ScholarPubMed
Meador, KJ, Loring, DW. Developmental effects of antiepileptic drugs and the need for improved regulations. Neurology. 2016;86(3):297–306.CrossRefGoogle ScholarPubMed
Veroniki, AA, Rios, P, Cogo, E, et al. Comparative safety of antiepileptic drugs for neurological development in children exposed during pregnancy and breast feeding: A systematic review and network meta-analysis. BMJ Open. 2017;7(7):1–11.CrossRefGoogle ScholarPubMed
Cohen, MJ, Meador, KJ, May, R, et al. Fetal antiepileptic drug exposure and learning and memory functioning at 6 years of age: The NEAD prospective observational study. Epilepsy Behav. 2019;92:154–64. https://doi.org/10.1016/j.yebeh.2018.12.031.CrossRefGoogle ScholarPubMed
Huber-Mollema, Y, Oort, FJ, Lindhout, D, Rodenburg, R. Behavioral problems in children of mothers with epilepsy prenatally exposed to valproate, carbamazepine, lamotrigine, or levetiracetam monotherapy. Epilepsia. 2019;60(6):1069–82.CrossRefGoogle ScholarPubMed
Videman, M, Stjerna, S, Wikström, V, et al. Prenatal exposure to antiepileptic drugs and early processing of emotionally relevant sounds. Epilepsy Behav. 2019;100:106503. https://doi.org/10.1016/j.yebeh.2019.106503.CrossRefGoogle ScholarPubMed
Huber-Mollema, Y, Van Iterson, L, Oort, FJ, Lindhout, D, Rodenburg, R. Neurocognition after prenatal levetiracetam, lamotrigine, carbamazepine or valproate exposure. J Neurol. 2020;267(6):1724–36. https://doi.org/10.1007/s00415-020-09764-w.CrossRefGoogle ScholarPubMed
Voinescu, PE, Pennell, PB. Management of epilepsy during pregnancy. Expert Review of Neurotherapeutics. 2015;15:1171–87.CrossRefGoogle ScholarPubMed
Huang, C-Y, Dai, Y-M, Feng, L-M, Gao, W-L. Clinical characteristics and outcomes in pregnant women with epilepsy. Epilepsy Behav. 2020;112:107433. https://doi.org/10.1016/j.yebeh.2020.107433.CrossRefGoogle ScholarPubMed
Hernández-Díaz, S, McElrath, TF, Pennell, PB, et al. Fetal growth and premature delivery in pregnant women on antiepileptic drugs. Ann Neurol. 2017;82(3):457–65.CrossRefGoogle ScholarPubMed
Pilo, C, Wide, K, Winbladh, B. Pregnancy, delivery, and neonatal complications after treatment with antiepileptic drugs. Acta Obstet Gynecol Scand. 2006;85(6):643–6.CrossRefGoogle ScholarPubMed
Burja, S, Rakovec-Felser, Z, Treiber, M, Hajdinjak, D, Gajšek-Marchetti, M. The frequency of neonatal morbidity after exposure to antiepileptic drugs in utero: A retrospective population-based study. Wiener Klin Wochenschrift. Suppl. 2006;118(2):12–16.CrossRefGoogle ScholarPubMed
Kazmin, A, Wong, RC, Sermer, M, Koren, G. Antiepileptic drugs in pregnancy and hemorrhagic disease of the newborn: An update. Canadian Family Physician. 2010;56:1291–2.Google ScholarPubMed
Kaaja, E, Kaaja, R, Matila, R, Hiilesmaa, V. Enzyme-inducing antiepileptic drugs in pregnancy and the risk of bleeding in the neonate. Neurology. 2002;58(4):549–53.CrossRefGoogle ScholarPubMed
Harden, CL, Meador, KJ, Pennell, PB, et al. Practice parameter update: Management issues for women with epilepsy. Focus on pregnancy (an evidence-based review). Teratogenesis and perinatal outcomes. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee. Neurology. 2009;73(2):133–41. www.neurology.org/content/73/2/142.abstract.Google ScholarPubMed
Barroso, FVL, Araujo, E, Guazelli, CAF, et al. Perinatal outcomes from the use of antiepileptic drugs during pregnancy: A case-control study. J Matern Neonatal Med. 2015;28(12):1445–50.Google ScholarPubMed
Chen, D, Hou, L, Duan, X, et al. Effect of epilepsy in pregnancy on fetal growth restriction: A systematic review and meta-analysis. Arch Gynecol Obstet. 2017;296(3):421–7.CrossRefGoogle ScholarPubMed
Galappatthy, P, Liyanage, CK, Lucas, MN, et al. Obstetric outcomes and effects on babies born to women treated for epilepsy during pregnancy in a resource limited setting: A comparative cohort study. BMC Pregnancy Childbirth. 2018;18(1):1–11.CrossRefGoogle Scholar
Fonager, K, Larsen, H, Pedersen, L, Sørensen, HT. Birth outcomes in women exposed to anticonvulsant drugs. Acta Neurol Scand. 2000;101(5):289–94.CrossRefGoogle ScholarPubMed
Holmes, LB, Harvey, EA, Brown, KS, Hayes, AM, Khoshbin, S. Anticonvulsant teratogenesis: I. A study design for newborn infants. Teratology. 1994;49(3):202–7.CrossRefGoogle Scholar
Pennell, PB, Klein, AM, Browning, N, et al. Differential effects of antiepileptic drugs on neonatal outcomes. Epilepsy Behav. 2012;24(4):449–56. http://dx.doi.org/10.1016/j.yebeh.2012.05.010.CrossRefGoogle ScholarPubMed
Bansal, R, Jain, G, Kharbanda, PS, Goyal, MK, Suri, V. Maternal and neonatal complications during pregnancy in women with epilepsy. Indian J Rheumatol. 2016;3(2):80–5. http://dx.doi.org/10.1016/j.ijep.2016.09.001.Google Scholar
Centers for Disease Control and Prevention, Division of Birth Defects and Developmental Disabilities. Facts about microcephaly. Atlanta, GA: Centers for Disease Control and Prevention;2016.Google Scholar
Videman, M, Tokariev, A, Stjerna, S, et al. Effects of prenatal antiepileptic drug exposure on newborn brain activity. Epilepsia. 2016;57(2):252–62.CrossRefGoogle ScholarPubMed
Satar, M, Ortaköylü, K, Batun, İ, et al. Withdrawal syndrome and hypomagnesaemia in a newborn exposed to valproic acid and carbamazepine during pregnancy. Turk Pediatr Ars. 2016;51(2):114–16.CrossRefGoogle Scholar
Hernández-Díaz, S, Smith, CR, Shen, A, et al. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012;78(21):1692–9.CrossRefGoogle ScholarPubMed
Veroniki, AA, Cogo, E, Rios, P, et al. Comparative safety of anti-epileptic drugs during pregnancy: A systematic review and network meta-analysis of congenital malformations and prenatal outcomes. BMC Med. 2017;15(1):1–20.CrossRefGoogle ScholarPubMed
Souza, SWD, Robertson, IG, Donnai, D, Mawer, G. Fetal phenytoin exposure, hypoplastic nails, and jitteriness. Arch Dis Child. 1990;65:320–4.Google Scholar
Veiby, G, Bjørk, M, Engelsen, BA, Gilhus, NE. Epilepsy and recommendations for breastfeeding. Seizure. 2015;28:57–65. http://dx.doi.org/10.1016/j.seizure.2015.02.013CrossRefGoogle ScholarPubMed
Ebbesen, F, Holsteen, V, Rix, M, et al. Neonatal hypoglycaemia and withdrawal symptoms after exposure in utero to valproate. Arch Dis Child Fetal Neonatal Ed. 2000;83(2):124–9.CrossRefGoogle ScholarPubMed
Carrasco, M, Rao, SC, Bearer, CF, Mbbs, SS. Pediatric neurology neonatal gabapentin withdrawal syndrome. Pediatr Neurol. 2015;53(5):445–7. http://dx.doi.org/10.1016/j.pediatrneurol.2015.06.023.CrossRefGoogle ScholarPubMed
Kanemura, A, Masamoto, H, Kinjo, T, Mekaru, K. Evaluation of neonatal withdrawal syndrome in neonates delivered by women taking psychotropic or anticonvulsant drugs: A retrospective chart review of the effects of multiple medication. Eur J Obstet Gynecol. 2020;254:226–30. https://doi.org/10.1016/j.ejogrb.2020.09.008.CrossRefGoogle ScholarPubMed
Chen, CY, Li, X, Ma, LY, et al. In utero oxcarbazepine exposure and neonatal abstinence syndrome: Case report and brief review of the literature. Pharmacotherapy. 2017;37(7):e71–5.CrossRefGoogle ScholarPubMed
Rolnitsky, A, Merlob, P, Klinger, G. Pediatric neurology in utero oxcarbazepine and a withdrawal syndrome, anomalies, and hyponatremia. Pediatr Neurol. 2013;48(6):466–8. http://dx.doi.org/10.1016/j.pediatrneurol.2013.02.012CrossRefGoogle Scholar
Mangat, AK, Schmölzer, GM, Kraft, WK. Pharmacological and non-pharmacological treatments for the neonatal abstinence syndrome (NAS). Semin Fetal Neonatal Med. 2019;24(2):133–41. https://doi.org/10.1016/j.siny.2019.01.009.CrossRefGoogle ScholarPubMed
Dubnov-Raz, G, Shapiro, R, Merlob, P. Maternal lamotrigine treatment and elevated neonatal gamma-glutamyl transpeptidase. Pediatr Neurol. 2006;35(3):220–2.CrossRefGoogle ScholarPubMed
Minkoff, H, Schaffer, RM, Delke, I , Grunebaum, AN. Diagnosis of intracranial hemorrhage in utero after a maternal seizure. Obs Gynecol. 1985;65:22S–24S.Google ScholarPubMed
Sherer, DM, Anyaegbunam, A, Onyeije, C. Antepartum fetal intracranial hemorrhage, predisposing factors and prenatal sonography: A review. American Journal of Perinatology. 1998;15:431–41.CrossRefGoogle ScholarPubMed
Veiby, G, Daltveit, AK, Schjølberg, S, et al. Exposure to antiepileptic drugs in utero and child development: A prospective population-based study. Epilepsia. 2013;54(8):1462–72.CrossRefGoogle ScholarPubMed
Vinten, J, Adab, N, Kini, U, et al. Neuropsychological effects of exposure to anticonvulsant medication in utero. Neurology. 2005;64(6):949–54.CrossRefGoogle ScholarPubMed
Øyen, N, Vollset, SE, Eide, MG, Bjerkedal, T, Skjærven, R. Maternal epilepsy and offsprings’ adult intelligence: A population-based study from Norway. Epilepsia. 2007;48(9):1731–8.CrossRefGoogle ScholarPubMed
Güveli, BT, Rosti, RÖ, Güzeltaş, A, et al. Teratogenicity of antiepileptic drugs. Clin Psychopharmacol Neurosci. 2017;15(1):19–27.CrossRefGoogle ScholarPubMed
Meador, KJ, Baker, GA, Browning, N, et al. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): A prospective observational study. Lancet Neurol. 2013;12(3):244–52.CrossRefGoogle ScholarPubMed
Banach, R, Boskovic, R, Einarson, T, Koren, G. Long-term developmental outcome of children of women with epilepsy, unexposed or exposed prenatally to antiepileptic drugs: A meta-analysis of cohort studies. Drug Saf. 2010;33(1):73–9.CrossRefGoogle ScholarPubMed
Daugaard, CA, Pedersen, L, Sun, Y, Dreier, JW, Christensen, J. Association of prenatal exposure to valproate and other antiepileptic drugs with intellectual disability and delayed childhood milestones. JAMA Netw Open. 2020;3(11):e2025570.CrossRefGoogle ScholarPubMed
Coste, J, Blotiere, PO, Miranda, S, et al. Risk of early neurodevelopmental disorders associated with in utero exposure to valproate and other antiepileptic drugs: A nationwide cohort study in France. Sci Rep. 2020;10(1):1–11. https://doi.org/10.1038/s41598-020-74409-xCrossRefGoogle ScholarPubMed
Christensen, J, Grønborg, TK, Sørensen, MJ, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA. 2013;309(16):1696–1703.CrossRefGoogle ScholarPubMed
Christensen, J, Pedersen, L, Sun, Y, et al. Association of prenatal exposure to valproate and other antiepileptic drugs with risk for attention-deficit/hyperactivity disorder in offspring. JAMA Netw Open. 2019;2(1):e186606.CrossRefGoogle ScholarPubMed
Meador, KJ, Pennell, PB, May, RC, Brown, CA, Baker, G. Effects of periconceptional folate on cognition in children of women with epilepsy. Neurology. 2020;94 (7):729–40.CrossRefGoogle ScholarPubMed
Vajda, FJE, O’Brien, TJ, Graham, JE, et al. Seizures in infancy in the offspring of women with epilepsy. Acta Neurol Scand. 2020;141(1):33–7.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×