What are the attitudes, barriers and enablers to physical activity perceived by pregnant women?
What are the attitudes, barriers and enablers to physical activity perceived by pregnant women?
In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework.
Attitudes and perceived barriers and enablers to physical activity during pregnancy.
Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity.
Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women’s positive attitudes into increased physical activity participation.
Physical activity has substantial benefits for women with uncomplicated pregnancies, minimal risks, and is recommended in pregnancy guidelines.1, 2, 3 The benefits of physical activity during pregnancy include improved physical fitness,3, 4, 5 reduced risk of excessive weight gain,6 reduced risk of pre-eclampsia and pre-term birth,7reduced low back pain,8, 9 improved sleep,10 reduced anxiety and depressive symptoms,11, 12 and improved health perception13 and self-reported body image.14
Physical activity is also important for pregnant women with comorbidities and complications such as obesity1 or gestational diabetes mellitus (GDM).15, 16, 17 Physical activity assists with weight control and reduces the risk of GDM in obese pregnant women.1 In women diagnosed with GDM (a common pregnancy-related complication occurring in 3.5 to 12% of pregnancies),15, 16 physical activity is beneficial as an adjunctive intervention in the management of glycaemic control.15, 17, 18, 19, 20 Managing glycaemic control is critical for reducing adverse effects associated with poorly controlled GDM.21 Consequently, aerobic exercise performed at moderate intensity for 30 minutes on most days of the week is recommended for healthy pregnant women,1, 3 those with GDM15, 22,23 and those who are overweight or obese.24
Despite well-documented health benefits,1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 24, 25, 26, 27 60 to 80% of pregnant women28, 29, 30, 31 – including those who are overweight or obese31 – and more than 60% of women with GDM32 do not participate in physical activity as recommended. Pregnant women from backgrounds other than Caucasian are also less likely to engage in physical activity.29 However, to improve pregnant women’s participation in physical activity (ie, leisure time physical activities or structured exercise programs), we need to understand their attitudes to it, the reasons why they do not engage in physical activity, and enablers that could be harnessed to design effective physical activity interventions or programs that facilitate behaviour change and thereby improve their participation in physical activity during pregnancy.
The inclusion of behaviour change techniques into physical activity interventions has been reported as helpful in improving physical activity levels during pregnancy.33 Behaviour change techniques such as goal setting, planning and education to shape knowledge appear most effective when delivered with face-to-face feedback about goal achievement.33 However, to facilitate uptake of these effective physical activity interventions, clinicians need to know which barriers, enablers and attitudes are common among pregnant women, so they can effectively target their education and evidence-based behaviour change strategies. A systematic review of barriers, enablers and attitudes of pregnant women to physical activity would provide valuable information to enable clinicians to effect a positive behaviour change of increased physical activity in this group.
Identification of women’s attitudes and perceptions of barriers and enablers to physical activity in pregnancy could be informed by quantitative or qualitative research approaches. A review that collates data from studies using either method would benefit from the advantages of each: improving generalisability and providing deeper insights into pregnant women’s beliefs and perceptions about physical activity during pregnancy. Inclusion of qualitative findings may assist in better understanding the factors that can influence women’s attitudes and perceptions. Such deeper understanding would provide valuable insight that clinicians can use to plan strategies to encourage pregnant women – in particular at-risk groups of women such as those with GDM – to participate in physical activity. It would also inform the design of realistic and acceptable interventions to be tested in an effectiveness study. No systematic review has collated quantitative data or provided a meta-summary of attitudes and perceptions of barriers and enablers to physical activity in pregnant women.
Therefore, the research question for this review was:
What are the attitudes, barriers and enablers to physical activity perceived by pregnant women, including women diagnosed with gestational diabetes mellitus?
Depression is sometimes described as a disease of modernity, as sharp changes in lifestyle during the last century or so have given rise to many chronic disorders including or linked to depression. Depression is a state of low mood: the person affected tends to lose interest in previously enjoyable activities. In severe cases, self-harm is also possible. Fortunately, there are many options available today to help treat this condition.
Research studies and statistics show that although pregnant women are less prone to major depression, they are more inclined to minor depressive episodes. The prevalence of depression can be anywhere between 8–16% among pregnant women. There are also higher chances that diagnosis of depression is overlooked in pregnant women.
The treatment of depression is quite challenging in pregnancy, as medical specialists have to weigh the benefits of treatment against the risks for the mother and the health of her unborn baby. Furthermore, the health professional has to take into consideration the risks and benefits of any such therapy to the long-term health of the child. New research seems to indicate that treatment of pregnant women with antidepressant drugs may increase the risk of autism, disturbances in motor function, and mental health problem in children. Some of these issues may become clear later in the life, thus studying this subject remains a challenge for researchers.
Why treat depression in pregnancy?
There is a widespread misconception that depression is not as threatening as other medical illnesses. Thus, treating depression is viewed as a matter of choice or even a luxury. Moreover, many patients that are on antidepressant drugs before pregnancy are in the remissive stage. Therefore, their doctors may think of discontinuing the therapy.
However, if a pregnant woman that is vulnerable to depression is not provided with antidepressant therapy, there is a higher risk of preterm birth, low birth weight, substance abuse in pregnancy (e.g., smoking and drinking alcohol), and a significantly higher risk of postpartum depression.
Research has shown that if antidepressants are discontinued for the period of the pregnancy, the relapse rate of major depression is as high as 60–70%. This can have severe consequences for the patient, family, and child. In addition, children born to mothers with untreated depression have higher levels of cortisol, which may have adverse impacts on their health.
As already mentioned, the use of antidepressants in pregnancy is a complicated issue due to possible dangers. Below are some of the common problems associated with the use of antidepressants during pregnancy.
Persistent pulmonary hypertension
This is a failure of lungs blood vessels to dilate in a child post-birth. Thus, a new-born may have breathing difficulties, a deficit of oxygen in the blood, leading to intubation. In many cases, outcomes may be fatal. This condition is also found to be related to maternal smoking, diabetes, and sepsis. Though the risk of persistent pulmonary hypertension in new-born increases up to six times with the use of antidepressants, at the same time there is a consensus among the medical community that non-use of antidepressants may be even more harmful.
This is also called “poor neonatal adaptation.” These symptoms are common when a mother has been exposed to antidepressants during the third trimester of pregnancy. Some of the symptoms characteristic of this syndrome include difficulties in breathing, unstable body temperature, hypo- or hypertonia, irritability, constant crying, and seizures. Therefore, some specialists recommend tapering the dose of antidepressants in the third trimester.
By motor development, we mean child’s ability to move around and handle the environment. There are clinical studies that indicate that the use of antidepressants during pregnancy may slow the motor development. A child may start walking later than other kids, or may have other problems related to movements.
Autism spectrum disorders
This is a neurodevelopmental disorder of children. Studies seem to show the modest increase in the risk of autism if a mother is exposed to antidepressants during the first trimester. However, no link has been found if such treatment has been given before the pregnancy, nor much relationship has been demonstrated if the therapy was initiated in a later phase of pregnancy. Thus, researchers caution that decision of prescribing antidepressants should be taken on a case by case basis by analysing the risks and potential benefits for maternal and child health.
In one of the large-scale studies, scientists analysed the data of almost one million births, and they found that the use of antidepressants in pregnancy was related to higher risk of developing psychiatric disorders later in life. Nonetheless, at the same time, researchers cautioned against jumping to the quick conclusions because it is a well-known fact that mental disorders have relation to genetics. It means that women prescribed antidepressants during the pregnancy have higher chances of passing to children the genes that may result in psychiatric diseases later in life.
Although antidepressants may increase the risk of specific disorders in the new-born babies or may even have a negative impact later in the life, it does not mean that antidepressants should not be taken during the pregnancy. It is essential that women should not feel guilty about taking such drugs. The medical specialists must be aware of the risks and weigh them against the benefits before they prescribe antidepressants to pregnant women.
Casper, R.C., Fleisher, B.E., Lee-Ancajas, J.C., Gilles, A., Gaylor, E., DeBattista, A., Hoyme, H.E., 2003. Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy. J. Pediatr. 142, 402–408. doi:10.1067/mpd.2003.139
Croen, L.A., Grether, J.K., Yoshida, C.K., Odouli, R., Hendrick, V., 2011. Antidepressant Use During Pregnancy and Childhood Autism Spectrum Disorders. Arch. Gen. Psychiatry 68, 1104–1112. doi:10.1001/archgenpsychiatry.2011.73
Ko, J.Y., Farr, S.L., Dietz, P.M., Robbins, C.L., 2012. Depression and Treatment Among U.S. Pregnant and Nonpregnant Women of Reproductive Age, 2005–2009. J. Womens Health 2002 21, 830–836. doi:10.1089/jwh.2011.3466
Payne, J.L., Meltzer-Brody, S., 2009. Antidepressant Use During Pregnancy: Current Controversies and Treatment Strategies. Clin. Obstet. Gynecol. 52, 469–482. doi:10.1097/GRF.0b013e3181b52e20
The dangerous drug attorneys at the Law Offices of Gregory Krasovsky can provide legal advice and representation to individuals and families considering pursuing a Keppra lawsuit. In order for a plaintiff to secure a maximum settlement in litigation of a Keppra claim, regardless of whether in an individual lawsuit or in a class action lawsuit, it is crucial that the law firm representing you have a competent and experienced team of Keppra lawyers to guide you through all of the legal hurdles as well as direct you to sufficient funding (litigation funding or legal finance) to cover pharmaceutical litigation costs. Contact a Keppra attorney today to schedule a free consultation and take your first step to obtaining compensation for losses caused by Keppra side effects.
Keppra, which is generically known as Levetiracetam, is an anticonvulsant drug used to treat epilepsy. Keppra was originally manufactured and marketed by UCB Pharmaceuticals Inc., but now it is available as a generic and is manufactured by a number of firms. Unfortunately, Keppra has a number of serious side effects that can, at times, outweigh its benefits for people who are suffering from epilepsy. Some of the most serious Keppra adverse effects include suicidal tendencies and birth defects.
There are many Levetiracetam side effects. These include, but are not limited to, the following:
A 2005 Food and Drug Administration (FDA) study of suicidal ideation in relation to epilepsy drugs has indicated that people taking those drugs, such as Keppra, are twice as likely to suffer from suicidal thoughts as are those who have not been taking these drugs.
Unlike many other drugs, such as Wellbutrin, people taking Keppra are likely to experience suicidal ideation regardless of what age group they might happen to fall into. The aforementioned study tracked almost 30,000 people, and the rick of suicide was spread fairly evenly across the population. Of the 28,000 people who had taken Keppra in this study, four of them had actually committed suicide. These unfortunate incidents serve to confirm the danger of this unsafe drug.
Although Keppra’s ability to cause birth defects is still under investigation, there is some amount of evidence that seems to confirm that Keppra is more harmful to unborn babies than was previously thought. Currently, the FDA has placed Keppra in the Category C for pregnancy, which indicates that there is little human risk. However, AdverseEvents, Inc. believes that Keppra should perhapd be in Category D, which indicates that a significant enough risk to pregnancy exists.
Keppra is similar to another prototypical nootropic drug called piracetam. Keppra is also thought to be a possible treatment for Tourette syndrome, autism, bipolar disorder, and anxiety disorder.
The attorneys at this Keppra law firm believe that drugs should not cause the same ailments that they are meant to cure. If you or your loved one has been injured as a result of taking Keppra, you might be entitled to compensation. Contact our attorneys today to schedule a free consultation.
Children whose mothers have taken anti-epilepsy medicine during pregnancy, do not visit the doctor more often than children who have not been exposed to this medicine in utero. This is the result of a new study from Aarhus.
Previous studies have shown that anti-epilepsy medicine may lead to congenital malformations in the foetus and that the use of anti-epilepsy medicine during pregnancy affects the development of the brain among the children. There is still a lack of knowledge in the area about the general health of children who are exposed to anti-epilepsy medicine in foetallife. But this new study is generally reassuring for women who need to take anti-epilepsy medicine during their pregnancy.
Being born to a mother who has taken anti-epilepsy medicine during pregnancy appears not to harm the child’s health. These are the findings of the first Danish study of the correlation between anti-epilepsy medicine and the general health of the child which has been carried out by the Research Unit for General Practice, Aarhus University and Aarhus University Hospital.
The results have just been published in the international scientific journal BMJ Open.
The researchers have looked into whether children who have been exposed to the mother’s anti-epilepsy medicine have contact with their general practitioner (GP) more often than other children – and there are no significant differences.
No reason til worry
“Our results are generally reassuring for women who need to take anti-epilepsy medicine during their pregnancy, including women with epilepsy,” says Anne Mette Lund Würtz, who is one of the researchers behind the project.
The difference in the number of contacts to the general practitioner between exposed and non-exposed children is only three per cent.
“The small difference we found in the number of contacts is primarily due to a difference in the number of telephone contacts and not to actual visits to the GP. At the same time, we cannot rule out that the difference in the number of contacts is caused by a small group of children who have more frequent contact with their GP because of illness,” explains Anne Mette Lund Würtz.
Of the 963,010 children born between 1997 and 2012, who were included in the survey, anti-epilepsy medicine was used in 4,478 of the pregnancies that were studied.
Anti-epilepsy medicine is also used for the treatment of other diseases such as migraine and bipolar disorder. The study shows that there were no differences relating to whether the women who used anti-epilepsy medicine during pregnancy were diagnosed with epilepsy or not.
Background for the results
Type of study: The population study was carried out using the Danish registers for the period 1997-2013.
The analyses takes into account differences in the child’s gender and date of birth, as well as the mother’s age, family situation, income, level of education, as well as any mental illness, use of psychiatric medicine and insulin, and substance abuse.
Written By Drusilla Moorhouse
Don’t you dare put that spoon in my mouth.
Epilepsy, also known as a seizure disorder, is a disorder of the brain that causes recurrent, unprovoked seizures. Those seizures are caused by surges of electrical activity in the brain, often compared to an electric storm.
In most cases, the cause of epilepsy is unknown. “Our challenge now is to understand the genetic architecture underlying each individual epilepsy,” Dr. Ley Sander, medical director at the Epilepsy Society in the U.K. and professor of neurology at University College London, told BuzzFeed. “We are also trying to understand why some people will respond well to a certain drug while others won’t.”
In fact, most people with epilepsy experience “partial” (or focal) seizures. These affect one area of the brain and can result in an aura, physiological reactions, or motor and sensory changes. They can cause a person to stare blankly and/or smack their lips, pluck at their clothing, wander around, or perform other bizarre (but involuntary) actions.
The dramatic convulsions that most people associate with epilepsy are a result of a seizure affecting both sides of the brain at once. These “generalized” seizures can also cause “staring spells,” brief body jerking, and “drop attacks” (suddenly falling to the ground).
When a person is having a convulsive seizure (or you know/they have indicated they are about to), gently roll them on one side (to allow any fluids to drain out of their mouth and keep their airway open), support their head, remove any dangerous objects nearby (including their glasses), and time the seizure.
If a seizure lasts longer than five minutes, call 911.
“Seizures usually end within a few minutes and keeping a person safe from injury during a seizure and paying attention to the seizure duration are the best first aid,” Dr. John Stern, director of the Epilepsy Clinical Program at UCLA, tells BuzzFeed. “If a seizure is longer than five minutes, then the risks may be greater and emergency care may become more important. If a person is not known to already have epilepsy or has a complicated medical condition, then emergency care may be needed sooner.”
For other types of seizures, it is important to remain with the person, gently guide them from danger (but avoid restraining them), and call 911 if the seizure lasts longer than five minutes.
It’s physically impossible to swallow your tongue, and a “bite block” (wooden spoon, wallet, etc.) could cause serious injury.
A person having a convulsive seizure may briefly stop breathing and have a blue skin color, but Stern explains that “this is mostly due to the diaphragm becoming stiff along with the other muscles for breathing.”
This is normal and brief, and the person will start breathing normally again as soon as their muscles relax. Do not attempt mouth-to-mouth or CPR during a convulsive seizure. Positioning the person on their side with their mouth pointed downward is the best way to keep their airway open.
They will be very confused and disoriented (after my first seizure I believed I had been in a plane crash!), and usually surrounded by frightened faces. It is extremely helpful if you are direct and candid and explain what just happened, who and where you are, and try to give them as much privacy as possible.
And if a person has urinated (which can happen with some seizures), cover that up to help limit any embarrassment, suggests Sander. Because after reassuring us and making sure we’re safe, the best thing you can do is help us restore our dignity.
Seizures are truly terrifying, whether you’re the person experiencing an aura or someone witnessing a grand mal seizure with convulsions. During a seizure, you lose consciousness, your muscles violently contract (I once broke a bed frame during a seizure), and your skin often turns blue from lack of oxygen.
Although we aren’t awake for the convulsions (and don’t remember them afterward), the aura preceding them (which is actually a seizure itself) is frightening for a host of other reasons: We could just be enjoying a hilarious kitten video at home or out running errands when suddenly we’re overcome by one or more of these unnerving sensations: a feeling of dread, déjà vu, blurry or tunnel vision, a strange sensation in our bellies, and/or the inability to speak.
Fortunately, my own auras last long enough that I’m able to text people to alert them about what’s happening (I have aphasia so I can’t actually tell them) but that also means that I have longer to experience the terrifying knowledge that my brain is about to fuck me up big time.
Picture yourself fleeing an evil witch who wants to take your little dog Toto when suddenly a tornado strikes and you’re tossed around in a twister. Then you wake up and don’t know where you are (it’s definitely not Kansas) or why the fuck you’re surrounded by diminutive townspeople singing your praises in an absurdly bright, colorful, and unfamiliar place.
Imagine the worst hangover of your life, combined with food poisoning, a migraine, sore muscles, and memory loss. Like Dorothy in Oz, you don’t just have a seizure and automatically return to normal.
“A seizure consists of a wave of abnormal electrical activity spreading through different parts of the brain,” explains Dr. Jacqueline French, a neurologist and the chief scientific officer for the Epilepsy Foundation. “Once the ‘wave’ of electricity goes past, the brain that it affected becomes exhausted, and often is unable to function.” That fog and confusion can last anywhere from a few minutes to a few days.
In fact, less than 2% of people with epilepsy have photosensitive epilepsy, says Sanders. They’re more commonly triggered by stress or being overtired.
Other common triggers include specific times of day or night (for instance, I’ve had most of my seizures just before sunset); sleep deprivation; stress; illness; flashing bright lights or patterns; caffeine, alcohol, or drug use; menstrual cycles or other hormonal changes; poor diet; and certain medications.
“Epilepsy affects everyone differently,” emphasizes Sander. “Although there can be similarities, people tend to have different triggers for their seizures, while some have none. Recognizing those triggers and trying to avoid them is an important part of self-management.”
Anti-epileptic drugs (AEDs), aka anticonvulsants, taken daily can control seizures “by reducing the excessive electrical activity in the brain that causes the seizures,” explains Sander. “The exact mechanism of AEDs is not well understood, but it is likely that different AEDs work in slightly different ways. The aim of optimal therapy is to get maximum seizure control with minimum side effects.”
According to the Epilepsy Foundation, medication controls seizures in about 7 out of 10 people with epilepsy.
“Although there is no anti-seizure medication that is proven safe during pregnancy, the risks for several are low and are believed to be reasonable in the context of the risks of seizures during pregnancy if treatment is stopped,” says Stern. “Pregnancy is overall safer when the seizures are best controlled, and this should be considered in the planning.”
Faye Waddams, who has documented her experience in the award-winning blog Epilepsy, Pregnancy, Motherhood and Me, tells BuzzFeed, “My neurologist advised me that although there is a risk with any anti-epileptic drug, my epilepsy was so uncontrolled that the risks of not taking it and having a seizure, causing harm to myself and the baby, was greater than any risk from the medication.”
And although Waddams (pictured above with her son, Noah) unfortunately did have seizures during her pregnancy despite the medication and was hospitalized several times, she is happy to report that she has “a healthy, happy, perfect baby boy who turns 1 this week.” (Waddams also ran a half marathon “nine months to the day” after giving birth to Noah!)
Eric Wheeler (shown above) is a marathoner and triathlete who — like many other athletes — also happens to have epilepsy. According to Stern, “A healthy lifestyle is important for everyone and it should not be avoided because of epilepsy. Moreover, some people with epilepsy find their seizures are better controlled when they are active. Exercise and recreation can help reduce stress, improve mood, and help brain health, which can benefit seizure control.”
Of course, seizures should be well-controlled — through medication, healthy habits (like avoiding known triggers), and sometimes even brain surgery — before a person with epilepsy participates in sports like triathlons.
As Stern emphasizes, “the activities need to be safe ones with regard to the person’s seizure risk.”
State laws require that most people with epilepsy be seizure-free for six months to a year before they can drive again.
“The driving restrictions vary among the states, but six months is a common period of restriction after a seizure,” says Stern. “This time period is somewhat arbitrary, but it relates to the fact that the likelihood of a seizure decreases as time passes after a seizure. Most of the risk is in the first year and much of it is in the first six months. The six-month period is intended to reduce the risk of injury at the time when the risk of a seizure is highest.”
The Epilepsy Foundation of America has a helpful database of state driving laws pertaining to epilepsy.
According to the World Health Organization, “Approximately 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.”
Many epilepsy advocacy organizations cite a startling statistic: One in 26 people will develop epilepsy in their lifetime. That number, based on a life expectancy of 80 years, “seems inaccurate because people do not talk about epilepsy even when they have it. In actuality, epilepsy is more common than Parkinson’s disease, multiple sclerosis, ALS, and cerebral palsy combined,” asserts French, the Epilepsy Foundation’s chief scientific officer.
Celebrities with epilepsy include Prince (who referenced his childhood epilepsy in the song “The Sacrifice of Victor”), the Beastie Boys’ Adam Horovitz, Danny Glover, Lil Wayne, Neil Young, NFL twins Tiki and Ronde Barber, and Harriet Tubman.
It’s easy to get caught up in the things that people with epilepsy lose: our dignity, our independence (especially when our driving privileges are revoked), and, for many, our ability to participate in certain activities ranging from scuba diving to bathing (because of the risk of drowning).
That’s why we appreciate every moment we have without a seizure, finding an anticonvulsant that is effective without debilitating side effects, and victories like being seizure-free for six months and longer.
We’re fighting like hell to not only manage this disease but also dispel the stigma associated with epilepsy. We are people to admire, not fear, and the best thing you can do for us is to learn more about this disease and first aid guidelines. Don’t be afraid to ask us questions — we want to talk about it!
Small British study says two drugs don’t harm a child’s mental development, but popular older one does
THURSDAY, Sept. 1, 2016 (HealthDay News) — Women who take the new epilepsy drugs levetiracetam and topiramate during pregnancy don’t run the risk of harming their infant’s mental development, British researchers report.
But the commonly prescribed anti-seizure drug valproate was linked with lower IQs in children, especially when taken at higher doses, researchers say.
“The treatment of epilepsy in women who are considering a pregnancy or are pregnant involves optimizing the health of the mother as well as keeping the risk to the fetus as low as possible,” said lead researcher Rebecca Bromley, a research fellow at the Institute for Human Development at the University of Manchester.
In the study, children exposed to levetiracetam (Keppra) or topiramate (Topamax) in the womb did not differ from children not exposed to these drugs. And they had better outcomes than the children exposed to valproate (Depakote) in terms of their IQ, thinking and language skills, Bromley said.
“These data can be used by doctors and women to help them make their decisions about which medication is best for them,” she added.
For the study, Bromley and her colleagues used the U.K. Epilepsy and Pregnancy Register to identify 171 women with epilepsy who had a child between 5 and 9 years old. During their pregnancy, 42 of the women took levetiracetam, 27 took topiramate, and 47 took valproate, the researchers said.
Bromley’s team compared the women with epilepsy with 55 women who did not take epilepsy drugs during pregnancy. The children had their IQ measured and took tests on verbal and nonverbal comprehension and how fast they could process visual information.
The researchers found that children of women who took levetiracetam or topiramate did not have lower IQs or other thinking-skill problems, compared with kids of mothers who did not take these drugs, no matter what dose of these drugs were taken.
Children whose mothers took valproate, however, had the lowest IQs of the study, Bromley said. These kids scored, on average, 11 points lower on the IQ test.
Among children whose mothers took valproate, 19 percent had IQs lower than the average score of 100, compared with 6 percent among kids whose mothers did not take any epilepsy drugs during pregnancy, the researchers found.
Because the registry the researchers used does not include all women with epilepsy, the findings might not apply to all women with the conditions, Bromley noted. She also said that topiramate, one of the newer drugs, has been associated with an increased risk of birth defects, such as cleft lip and palate.
The study was funded by Epilepsy Research U.K. and the report was published online Aug. 31 in the journal Neurology.
Dr. Ian Miller is a pediatric neurologist and medical director of the comprehensive epilepsy program at Nicklaus Children’s Hospital in Miami. “This study means that we have a little bit more information for women who become pregnant while taking epilepsy medicines,” he said.
The exact risks of taking any medicine during pregnancy are very difficult to know, he added.
“As a result, many questions remain,” Miller said. “But this study gives doctors a reason to choose topiramate or levetiracetam, which did not show a measurable effect on the child’s development, rather than valproate, which did.”
Women who are on valproate because they already tried other medications and “moved on because those medications were less effective, will face some difficult decisions,” he said.
“Any woman of childbearing potential should discuss this aspect of their medical management with their doctor, especially in light of these new findings,” Miller added.
SOURCES: Rebecca Bromley, Ph.D., research fellow, Institute for Human Development, University of Manchester, England; Ian Miller, M.D., pediatric neurologist, and medical director, comprehensive epilepsy program, Nicklaus Children’s Hospital, Miami; Aug. 31, 2016, Neurology, online
Published on April 18, 2016 at 2:19 PM<
Women with epilepsy are just as likely to achieve a successful pregnancy as women without the neurological disorder, according to a new study led by research teams at multiple centers, including NYU Langone Medical Center.
In a prospective study, women with epilepsy had a comparable likelihood of achieving pregnancy, time taken to get pregnant, and pregnancy outcomes such as miscarriage, compared to a group of healthy peers. These findings, presented April 17 at the American Academy of Neurology’s 68th Annual Meeting in Vancouver, contradict previously held beliefs in the medical community regarding the fertility of women with epilepsy.
More than 1.1 million U.S. women with epilepsy are of childbearing age and approximately 24,000 babies are born to women with epilepsy each year, according to figures from The Epilepsy Foundation, which funded the new research.
Previous studies have found infertility rates up to two to three times higher for women with epilepsy, or that as many as one-third of women with epilepsy may experience difficulty with pregnancy. But, a comprehensive study has not been done to date to confirm this until now, according to the researchers.
“We hope our findings reassure women with epilepsy and clinicians who are counseling these women on family planning,” says Jacqueline French, MD, professor of Neurology and Director of Translational Research and Clinical Trials at NYU Langone’s Comprehensive Epilepsy Center, and the study’s first author and co-principal investigator.
The researchers led a multicenter observational study called The Women with Epilepsy: Pregnancy Outcomes and Deliveries (WEPOD) from 2010 to 2015. Women with epilepsy and healthy control participants who were between the ages of 18 and 41 seeking pregnancy and less than six months removed from contraception were followed throughout the duration of their pregnancy. Electronic diaries captured use of anti-epileptic medications, seizures and facts about participants’ sexual activity and menstruation cycles.
In total, 89 women with epilepsy and 109 healthy controls with similar demographics were compared for the study. The proportion of women who achieved pregnancy was 70 percent for women with epilepsy and 67.1 percent for healthy controls.
Average time to pregnancy in women with epilepsy was 6.03 months, compared with 9.05 months for healthy controls, and after controlling for age, body mass index, parity and race, there was no difference across groups for time to pregnancy.
Of the pregnancies that occurred, a similar proportion resulted in live birth (81.8 percent women with epilepsy and 80 percent controls), miscarriage (12.7 percent women with epilepsy and 20 percent controls), or other outcomes (5.4 percent women with epilepsy compared to 0 percent healthy controls).
Gorman, Megan Othersen
Brandy Parker-McFadden had always considered herself one of the lucky ones, and by any measure she was. Diagnosed with epilepsy at age 15 after her first convulsive seizure, Parker-McFadden, now 40, has had just three seizures in the 25 years since. “I took my medications faithfully and went on with my life,” she says. “I grew up, I got married, and I had a baby—and then two more. Through it all, my epilepsy was well controlled with medication. From the outside, it was almost as though I didn’t have it.”
This was thanks in large part to valproate, an antiseizure medication prescribed by her neurologist that is often used to treat epilepsy and bipolar disorder and to prevent migraines. So when her neurologist instructed her obstetrician to increase the dosage during her first pregnancy to ensure that the medicine remained at a therapeutic level within her body, Parker-McFadden didn’t question it.
That was 12 years ago, in 2003. Parker’s firstborn, Samuel, is now 11.
“Samuel was born right around the time we got the first information on cognitive risks to babies exposed to valproate in utero,” says Kimford J. Meador, MD, a professor of neurology and neurological sciences at Stanford University Medical Center in California, clinical services director of the Stanford Comprehensive Epilepsy Program, and a Fellow of the American Academy of Neurology (FAAN). “There were hints in the epilepsy pregnancy registries [online databases cataloging the experiences of pregnant women taking epilepsy drugs], but what wasn’t fully known until 2004 is that one in 10 children exposed to valproate in utero will have a major complication—plus a 7- to 10-point drop in IQ. Verbal intelligence, in particular, is affected.”
WEB EXTRA: For more information about pregnacy and epilepsy, visithttp://bit.ly/NN-pregnancy-epilepsy.
At the beginning of spring in 2013, Mary Guest, a lively, accomplished 37-year-old woman, fell in love, became pregnant and married after a short courtship. At the time, Mary taught children with behavioral problems in Portland, Ore., where she grew up. Her supervisor said that he had rarely seen a teacher with Mary’s gift for intuiting students’ needs. “Mary was a powerful person,” he wrote to her mother, Kristin. “Around Mary, one felt compassion, drive, calmness and support.”
Mary had struggled with depression for much of her life. Starting in her 20s, she would sometimes say to Kristin that she just wanted to die. “She would always follow up by saying, ‘But you don’t need to worry, Mama,’ ” Kristin told me. “ ‘I don’t have a plan, and I don’t intend to do anything.’ ” In recent years, Mary and her mother went for a walk once a week, and Mary would describe the difficulties she was having. She was helped somewhat by therapy and by antidepressant and antianxiety medications, which blunted her symptoms.
Mary’s friends appreciated her wacky sense of humor and her engaging wit. Colleagues said that her moods never impinged on her work; in fact, few of them knew what she was dealing with. Yet for years Mary worried that she would never be in a stable relationship and experience love or a family of her own. She said plaintively to Kristin, “I think I would be a really good mother.”