GuidelineNeurology2009
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.
Guideline in Neurology, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 79 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
79 citing papers in PubMed, 1 synthesis or guideline pooled it, 303 citations in OpenAlex.
- Guideline
- Breastfeeding and Neurodevelopmental Outcomes in Children of Women Taking Antiseizure Medications.JAMA network open · 2026Observational
- Evaluation of the management of high-risk obstetric patients living with epilepsy: A retrospective study from KwaZulu-Natal, South Africa.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2026Article
- Antiseizure Medication Dosing Strategy During Pregnancy and Early Postpartum in Women With Epilepsy in MONEAD.Neurology · 2026Observational
- Improving Folic Acid Supplementation for Women of Childbearing Age With Epilepsy.Neurology. Clinical practice · 2025Article
- Dosing Optimization of Lamotrigine in Peripregnancy Epilepsy Through PopPK Modelling and Simulation.Drug design, development and therapy · 2025Article
- Whole-cycle management of women with epilepsy of child-bearing age: ontology construction and application.BMC medical informatics and decision making · 2024Article
- Management guidelines for pregnant women living with epilepsy: An integrative literature review.Health SA = SA Gesondheid · 2024Review
- Article
- Issues of Women with Epilepsy and Suitable Antiseizure Drugs.Journal of epilepsy research · 2023Review
- Empiric dosing strategies to predict lamotrigine concentrations during pregnancy.Pharmacotherapy · 2023Article
- Counseling on the Need for Folic Acid in Adolescents With Epilepsy.Neurology. Clinical practice · 2023Article
- A scoping review and critical evaluation of the methodological quality of clinical practice guidelines on nutrition in the preconception.Frontiers in nutrition · 2023Article
- Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade.Pharmaceutics · 2022Review
- Quality Appraisal of Nutritional Guidelines to Prevent, Diagnose, and Treat Malnutrition in All Its Forms during Pregnancy.Nutrients · 2022Review
- Contraception, fecundity, and pregnancy in women with epilepsy: an update on recent literature.Current opinion in neurology · 2022Review
- Epilepsy in Pregnancy-Management Principles and Focus on Valproate.International journal of molecular sciences · 2022Review
- Adherence of Saudi women with epilepsy to folic acid intake in the preconceptional period in two tertiary care hospitals in Riyadh: A cross sectional study.Epilepsy & behavior reports · 2022Article
- Bidirectional Relations Among Depression, Migraine, and Epilepsy: Do They Have an Impact on Their Response to Treatment?Current topics in behavioral neurosciences · 2022Review
- Changes in Seizure Frequency and Antiepileptic Therapy during Pregnancy.The New England journal of medicine · 2020Observational
19 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
23 authors at 10 institutions in 2 countries.
Funding
Abstract
objectiveTo reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid use, prenatal vitamin K use, risk of hemorrhagic disease of the newborn, clinical implications of placental and breast milk transfer of antiepileptic drugs (AEDs), risks of breastfeeding, and change in AED levels during pregnancy.
methodsA 20-member committee evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and October 2007.
resultsPreconceptional folic acid supplementation is possibly effective in preventing major congenital malformations in the newborns of WWE taking AEDs. There is inadequate evidence to determine if the newborns of WWE taking AEDs have a substantially increased risk of hemorrhagic complications. Primidone and levetiracetam probably transfer into breast milk in amounts that may be clinically important. Valproate, phenobarbital, phenytoin, and carbamazepine probably are not transferred into breast milk in clinically important amounts. Pregnancy probably causes an increase in the clearance and a decrease in the concentration of lamotrigine, phenytoin, and to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative. RECOMMENDATIONS: Supplementing women with epilepsy with at least 0.4 mg of folic acid before they become pregnant may be considered (Level C). Monitoring of lamotrigine, carbamazepine, and phenytoin levels during pregnancy should be considered (Level B) and monitoring of levetiracetam and oxcarbazepine (as monohydroxy derivative) levels may be considered (Level C). A paucity of evidence limited the strength of many recommendations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.