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Chapter 10 - Contraception and Prepregnancy Counseling

Published online by Cambridge University Press:  19 December 2024

By
Naveed Chaudhry  and
Emily Johnson
Edited by
Esther Bui  and
P. Emanuela Voinescu
Esther Bui
Affiliation:
Toronto Western Hospital
P. Emanuela Voinescu
Affiliation:
Brigham & Women's Hospital, Boston, MA
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Summary

Enzyme-inducing antiepileptic drugs (EI-ASMs) such as phenytoin, carbamazepine, oxcarbazepine, and phenobarbital may decrease contraceptive efficacy. When considering contraception for women with epilepsy (WWE), the intrauterine device (IUD) is a first line choice. It is important to keep in mind that hormonal contraception with estrogenic components induces the metabolism of lamotriginePreconception counseling should be started early and revisited frequently for WWE of childbearing age. Pre-partum optimization of ASMs ideally should be done 9−12 months before a planned pregnancy. The majority of WWE are likely to have a safe pregnancy and a healthy newborn.

Keywords

ContraceptionIUDwomenepilepsyanti-epileptic drugscounselingbreastfeedingregistry
Type
Chapter
Information
Women with Epilepsy
A Practical Management Handbook
 , pp. 168 - 190
Publisher: Cambridge University Press
Print publication year: 2025

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References

Harden, CL, Meador, KJ, Pennell, PB, et al. American Academy of Neurology; American Epilepsy Society. 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 of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73(2):133–41.Google Scholar
Tomson, T, Battino, D, Bonizzoni, E, et al. for the EURAP Study Group. 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.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
Mosher, WD, Jones, J. Use of contraception in the United States: 1982–2008. Vital Health Stat. 2010; 23(29):1–44.Google Scholar
Kavanaugh, ML, Jerman, J, Finer, LB. Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009–2012. Obstet Gynecol. 2015;126:917–27.CrossRefGoogle ScholarPubMed
Practice Parameter. Management issues for women with epilepsy (summary statement): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1998;51(4):944–8.Google Scholar
Herzog, AG, Mandle, HB, Cahill, KE, et al. Contraceptive practices of women with epilepsy: Findings of the Epilepsy Birth Control Registry. Epilepsia. 2016;57(4):630–7.CrossRefGoogle ScholarPubMed
Davis, AR, Pack, AM, Kritzer, J, et al. Reproductive history, sexual behavior and use of contraception in women with epilepsy. Contraception. 2008;77(6):405–9.CrossRefGoogle ScholarPubMed
Krauss, GL, Brandt, J, Campbell, M, et al. Antiepileptic medication and oral contraceptive interactions: A national survey of neurologists and obstetricians. Neurology. 1996; 46(6):1534–9.CrossRefGoogle ScholarPubMed
Long, L, Montouris, G. Knowledge of women’s issues and epilepsy (KOWIE-II): A survey of health care professionals. Epilepsy Behav. 2005;6(1):90–3.CrossRefGoogle ScholarPubMed
Pack, A, Davis, AR, Kritzer, J, et al. Antiepileptic drugs: Are women aware of interactions with oral contraceptives and potential teratogenicity? Epilepsy Behav. 2009;14(4):640–4.CrossRefGoogle ScholarPubMed
Winner, B, Peipert, JF, Zhao, Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012; 366(21):1998–2007.CrossRefGoogle ScholarPubMed
Ortiz, ME, Croxatto, HB. Copper-T intrauterine device and levonorgestrel intrauterine system: Biological bases of their mechanism of action. Contraception. 2007; 75(6 Suppl):S16–S30.CrossRefGoogle ScholarPubMed
ACOG Committee Opinion No. 735: Adolescents and long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol. 2018;131(5):e130–e139.CrossRefGoogle Scholar
Davis, AR, Saadatmand, HJ, Pack, A. Women with epilepsy initiating a progestin IUD: A prospective pilot study of safety and acceptability. Epilepsia. 2016;57(11):1843–8.CrossRefGoogle ScholarPubMed
Mohllajee, AP, Curtis, KM, Peterson, HB. Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review. Contraception. 2006;73(2):145–53.CrossRefGoogle ScholarPubMed
Farley, TM, Rosenberg, MJ, Rowe, PJ, et al. Intrauterine devices and pelvic inflammatory disease: An international perspective. Lancet. 1992;339(8796):785–8.CrossRefGoogle ScholarPubMed
Vieira, CS, Pack, A, Roberts, K, Davis, AR. A pilot study of levonorgestrel concentrations and bleeding patterns in women with epilepsy using a levonorgestrel IUD and treated with antiepileptic drugs. Contraception. 2019;99(4):251–5.CrossRefGoogle ScholarPubMed
Marions, L, Lövkvist, L, Taube, A, et al. Use of the levonorgestrel releasing-intrauterine system in nulliparous women: A non-interventional study in Sweden. Eur J Contracept Reprod Health Care. 2011;16(2):126–34.CrossRefGoogle ScholarPubMed
Madden, T, McNicholas, C, Zhao, Q, et al. Association of age and parity with intrauterine device expulsion. Obstet Gynecol. 2014;124(4):718–26.CrossRefGoogle ScholarPubMed
Johnson, EL. Contraception for women with epilepsy. Curr Obstet Gynecol Rep. 2018;7:146–52.CrossRefGoogle Scholar
Isley, MM, Kaunitz, AM. Update on hormonal contraception and bone density. Rev Endocr Metab Disord. 2011;12(2):93–106.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. US Medical Eligibility Criteria for Contraceptive Use, 2010. MMWR Recomm Rep. 2010;59(RR–4):1–86.Google Scholar
Kenyon, IE. Unplanned pregnancy in an epileptic. Br Med J. 1972;1:686–7.CrossRefGoogle Scholar
Gaffield, ME, Culwell Kelly, R, Lee, CR. The use of hormonal contraception among women taking anticonvulsant therapy. Contraception. 2011; 83:16–29.CrossRefGoogle ScholarPubMed
Stoffel-Wagner, B, Bauer, J, Flügel, D, et al. Serum sex hormones are altered in patients with chronic temporal lobe epilepsy receiving anticonvulsant medication. Epilepsia. 1998;39:1164–73.CrossRefGoogle ScholarPubMed
Bounds, W, Guillebaud, J. Observational series on women using the contraceptive Mirena concurrently with anti-epileptic and other enzyme-inducing drugs. J Fam Plann Reprod Health Care. 2002;28:78–80.CrossRefGoogle ScholarPubMed
Sabers, A, Ohman, I, Christensen, J, et al. Oral contraceptives reduce lamotrigine plasma levels. Neurology. 2003;61(4):570–1.CrossRefGoogle ScholarPubMed
Ohman, I, Luef, G, Tomson, T. Effects of pregnancy and contraception on lamotrigine disposition: New insights through analysis of lamotrigine metabolites. Seizure. 2008;17:199–202.CrossRefGoogle ScholarPubMed
Wegner, I, Edelbroek, PM, Bulk, S, et al. Lamotrigine kinetics within the menstrual cycle, after menopause, and with oral contraceptives. Neurology. 2009;73(17):1388–93.CrossRefGoogle ScholarPubMed
Herzog, AG, Blum, AS, Farina, EL, et al. Valproate and lamotrigine level variation with menstrual cycle phase and oral contraceptive use. Neurology. 2009;72:911–14.CrossRefGoogle ScholarPubMed
Herzog, AG, Harden, CL, Liporace, J, et al. Frequency of catamenial seizure exacerbation in women with localization-related epilepsy. Ann Neurol. 2004;56 (3):431–4.CrossRefGoogle ScholarPubMed
Harden, CL, Pennell, PB. Neuroendocrine considerations in the treatment of men and women with epilepsy. Lancet Neurol. 2013; 12(1):72–83.CrossRefGoogle ScholarPubMed
Herzog, AG. Differential impact of antiepileptic drugs on the effects of contraceptive methods on seizures: Interim findings of the Epilepsy Birth Control Registry. Seizure. 2015;28:71–5.CrossRefGoogle ScholarPubMed
Herzog, AG, Mandle, HB, MacEachern, DB. Differential risks of changes in seizure frequency with transitions between hormonal and non-hormonal contraception in women with epilepsy: A prospective cohort study. Epilepsy Behav. 2021;120:108011.CrossRefGoogle ScholarPubMed
Mattson, RH, Cramer, J, Caldwell, BV, et al. Treatment of seizures with medroxyprogesterone acetate: Preliminary report. Neurology. 1984;34:1255–8.CrossRefGoogle ScholarPubMed
Herzog, AG, Fowler, KM, Smithson, SD, et al. Progesterone vs. placebo therapy for women with epilepsy: A randomized clinical trial. Neurology. 2012;78(24):1959–66.CrossRefGoogle ScholarPubMed
Fairgrieve, SD, Jackson, M, Jonas, P, et al. Population based, prospective study of the care of women with epilepsy in pregnancy. BMJ (Clinical research ed). 2000;321 (7262):674–5.CrossRefGoogle ScholarPubMed
Bell, GS, Nashef, L, Kendall, S, et al. Information recalled by women taking anti-epileptic drugs for epilepsy: A questionnaire study. Epilepsy Res. 2002;52(2):139–46.CrossRefGoogle ScholarPubMed
May, TW, Pfafflin, M, Coban, I, et al. Fears, knowledge, and need of counseling for women with epilepsy: Results of an outpatient study. Der Nervenarzt. 2009;80 (2):174–83.Google ScholarPubMed
Vazquez, B, Gibson, P, Kustra, R. Epilepsy and women’s health issues: Unmet needs. Survey results from women with epilepsy. Epilepsy Behav. 2007;10(1):163–9.CrossRefGoogle ScholarPubMed
Winterbottom, JB, Smyth, RM, Jacoby, A, et al. Preconception counselling for women with epilepsy to reduce adverse pregnancy outcome. Cochrane Database Syst Revi. 2008;3:CD006645.Google Scholar
Crawford, P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005; 46(Suppl 9): 117–24.CrossRefGoogle ScholarPubMed
Aguglia, U, Barboni, G, Battino, D, et al. Italian Consensus Conference on Epilepsy and Pregnancy, Labor and Puerperium. Epilepsia. 2009;50(Suppl 1):7–23.CrossRefGoogle Scholar
Davis, AR, Pack, AM, Kritzer, J, et al. Reproductive history, sexual behavior and use of contraception in women with epilepsy. Contraception. 2008;77(6):405–9.CrossRefGoogle 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):1031–9.CrossRefGoogle ScholarPubMed
Crawford, P, Hudson, S. Understanding the information needs of women with epilepsy at different lifestages: Results of the “Ideal World” survey. Seizure. 2003;12(7):502–7.CrossRefGoogle ScholarPubMed
Helbig, KL, Bernhardt, BA, Conway, LJ, et al. Genetic risk perception and reproductive decision making among people with epilepsy. Epilepsia. 2010;51(9):1874–7.CrossRefGoogle ScholarPubMed
Winawer, MR, Shinnar, S. Genetic epidemiology of epilepsy or what do we tell families? Epilepsia. 2005;46(Suppl 10):24–30.CrossRefGoogle ScholarPubMed
Peljto, AL, Barker-Cummings, C, Vasoli, VM, et al. Familial risk of epilepsy: A population-based study. Brain. 2014;137(Pt 3):795–805.CrossRefGoogle ScholarPubMed
Holmes, LB, Harvey, EA, Coull, BA, et al. The teratogenicity of anticonvulsant drugs. New Engl J Med. 2001;344(15):1132–8.CrossRefGoogle ScholarPubMed
Morrow, J, Russell, A, Guthrie, E, et al. Malformation risks of antiepileptic drugs in pregnancy: A prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry. 2006;77(2):193–8.CrossRefGoogle ScholarPubMed
Hernandez-Diaz, S, Smith, CR, Shen, A, et al. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012;78(21):1692–9.CrossRefGoogle ScholarPubMed
Tomson, T, Battino, D, Bonizzoni, E, et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: A prospective cohort study of the EURAP registry. Lancet Neurol. 2018;17(6):530–8.CrossRefGoogle ScholarPubMed
Vajda, FJE, Graham, JE, Hitchcock, AA, et al. Antiepileptic drugs and foetal malformation: Analysis of 20 years of data in a pregnancy register. Seizure. 2019;65:6–11.CrossRefGoogle Scholar
Thomas, SV, Jose, M, Divakaran, S, Sankara Sarma, P. Malformation risk of antiepileptic drug exposure during pregnancy in women with epilepsy: Results from a pregnancy registry in south India. Epilepsia. 2017;58(2):274–81.CrossRefGoogle ScholarPubMed
Tomson, T, Battino, D. Teratogenic effects of antiepileptic drugs. Lancet Neurol. 2012;11(9):803–13.CrossRefGoogle ScholarPubMed
FDA Drug Safety Communication: Risk of oral clefts in children born to mothers taking Topamax (topiramate). 2011. www.fda.gov/Drugs/DrugSafety/ucm245085.htm.Google Scholar
Shallcross, R, Bromley, RL, Irwin, B, et al. Child development following in utero exposure: Levetiracetam vs. sodium valproate. Neurology. 2011;76(4):383–9. PubMed PMID: 21263139.CrossRefGoogle ScholarPubMed
Banach, R, Boskovic, R, Einarson, T, et al. 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
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.CrossRefGoogle ScholarPubMed
Meador, KJ, Baker, GA, Browning, N, et al. Effects of fetal antiepileptic drug exposure: Outcomes at age 4.5 years. Neurology. 2012;78(16):1207–14.Google 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
Meador, K, Reynolds, MW, Crean, S, et al. Pregnancy outcomes in women with epilepsy: A systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008;81(1):1–13.CrossRefGoogle ScholarPubMed
Holmes, LB, Mittendorf, R, Shen, A, et al. Fetal effects of anticonvulsant polytherapies: Different risks from different drug combinations. Arch Neurol. 2011;68(10):1275–81.CrossRefGoogle ScholarPubMed
Blencowe, H, Cousens, S, Modell, B, et al. Folic acid to reduce neonatal mortality from neural tube disorders. J Epidemiol. 2010;39(Suppl 1):i110–i21.Google ScholarPubMed
Medical Research Council Vitamin Study Research Group. Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study.Lancet. 1991;338(8760):131–7.Google Scholar
Kaaja, E, Kaaja, R, Hiilesmaa, V. Major malformations in offspring of women with epilepsy. Neurology. 2003;60(4):575–9.CrossRefGoogle ScholarPubMed
Kjaer, D, Horvath-Puho, E, Christensen, J, et al. Antiepileptic drug use, folic acid supplementation, and congenital abnormalities: A population-based case control study. BJOG 2008;115(1):98–103.CrossRefGoogle ScholarPubMed
Pittschieler, S, Brezinka, C, Jahn, B, et al. Spontaneous abortion and the prophylactic effect of folic acid supplementation in epileptic women undergoing antiepileptic therapy. J Neurol. 2008;255(12):1926–31.CrossRefGoogle ScholarPubMed
Harden, CL, Pennell, PB, Koppel, BS, et al. Practice parameter update: Management issues for women with epilepsy. Focus on pregnancy (an evidence-based review). Vitamin K, folic acid, blood levels, and breastfeeding. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009; 73(2):142–9.Google Scholar
Meador, KJ, Pennell, PB, May, RC, et al. Effects of periconceptional folate on cognition in children of women with epilepsy: NEAD study. Neurology. 2020; 94(7):729–40.CrossRefGoogle ScholarPubMed
Bjørk, M, et al. Association of folic acid supplementation during pregnancy with the risk of autistic traits in children exposed to antiepileptic drugs in utero. JAMA Neurology. 2018 ;75(2):160–8.Google ScholarPubMed
Wilson, RD, Davies, G, Desilets, V, et al. The use of folic acid for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can. 2003;25(11):959–73.Google ScholarPubMed
Harden, CL, Hopp, J, Ting, TY, et al. Practice parameter update: Management issues for women with epilepsy. Focus on pregnancy (an evidence-based review). Obstetrical complications and change in seizure frequency. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73(2):126–32.Google Scholar
Pennell, PB, French, JA, May, RC, et al. Changes in seizure frequency and antiepileptic therapy during pregnancy. N Engl J Med. 2020;383(26):2547–56.CrossRefGoogle ScholarPubMed
Pennell, PB, Peng, L, Newport, DJ, et al. Lamotrigine in pregnancy: Clearance, therapeutic drug monitoring, and seizure frequency. Neurology. 2008;70(22 Pt 2):2130–6.CrossRefGoogle ScholarPubMed
Sabers, A, Petrenaite, V. Seizure frequency in pregnant women treated with lamotrigine monotherapy. Epilepsia. 2009;50(9):2163–6.CrossRefGoogle ScholarPubMed
Kaplan, PW, Norwitz, ER, Ben-Menachem, E, et al. Obstetric risks for women with epilepsy during pregnancy. Epilepsy Behav. 2007;11(3):283–91.CrossRefGoogle ScholarPubMed
Adab, N, Kini, U, Vinten, J, et al. The longer term outcome of children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry. 2004;75(11):1575–83.CrossRefGoogle ScholarPubMed
EURAP Study Group. Seizure control and treatment in pregnancy: Observations from the EURAP epilepsy pregnancy registry. Neurology. 2006;66(3):354–60.Google Scholar
Rauchenzauner, M, Ehrensberger, M, Prieschl, M, et al. Generalized tonic-clonic seizures and antiepileptic drugs during pregnancy: A matter of importance for the baby? J Neurol. 2013;260(2):484–8.CrossRefGoogle ScholarPubMed
Chen, YH, Chiou, HY, Lin, HC, Lin, HL. Affect of seizures during gestation on pregnancy outcomes in women with epilepsy. Arch Neurol. 2009;66(8):979–84. https://doi.org/10.1001/archneurol.2009.142. PMID: 19667219.CrossRefGoogle Scholar
Birnbaum, AK, Meador, KJ, Karanam, A, et al. Antiepileptic drug exposure in infants of breastfeeding mothers with epilepsy. JAMA Neurol. 2020;77(4):441–50.Google ScholarPubMed
Meador, KJ, Baker, GA, Browning, N, et al. Breastfeeding in children of women taking antiepileptic drugs: Cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168(8):729–36.CrossRefGoogle ScholarPubMed
Klein, A. The postpartum period in women with epilepsy. Neurol Clin. 2012;30(3):867–75.CrossRefGoogle ScholarPubMed
Lossius, MI, Hessen, E, Mowinckel, P, et al. Consequences of antiepileptic drug withdrawal: A randomized, double-blind study (Akershus Study). Epilepsia. 2008;49(3):455–63.CrossRefGoogle ScholarPubMed
Decker, BM, Thibault, D, Davis, KA, Willis, AW. A nationwide analysis of maternal morbidity and acute postpartum readmissions in women with epilepsy. Epilepsy Behav. 2021;117:107874.CrossRefGoogle ScholarPubMed
Espinera, AR, Gavvala, J, Bellinski, I, Kennedy, J, Macken, MP, Narechania, A, Templer, J, VanHaerents, S, Schuele, SU, Gerard, EE. Counseling by epileptologists affects contraceptive choices of women with epilepsy. Epilepsy Behav. 2016;65:1–6. https://doi.org/10.1016/j.yebeh.2016.08.021.CrossRefGoogle ScholarPubMed

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