Evidence map›Paper›PMID 40439278›Full record

ArticleEpilepsia open2025

Ketogenic diet therapy for epilepsy during pregnancy and lactation: An international survey exploring clinician perspectives.

Kelly Faltersack, Tanya J W McDonald, Valentina De Giorgis, Bobbie Barron, Mackenzie C Cervenka, Anita Devlin, Laura A Healy, Magnhild Kverneland, Elles van der Louw, Mengyang Lu and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Epilepsia open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Kelly FaltersackDepartment of Clinical Nutrition, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA.ORCID https://orcid.org/0009-0009-6552-4992
Tanya J W McDonaldDepartment of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0001-5545-7612
Valentina De GiorgisDepartment of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy.ORCID https://orcid.org/0000-0002-5828-7070
Bobbie BarronInstitute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0001-5390-794X
Mackenzie C CervenkaDepartment of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0002-4760-857X
Anita DevlinDepartment of Paediatric Neurology, Great North Children's Hospital, Newcastle-Upon-Tyne & Translational and Clinical Research Institute, Newcastle University Chair of the ILAE Dietary Task Force, Newcastle upon Tyne, UK.ORCID https://orcid.org/0000-0002-3814-4777
Laura A HealyDepartment of Clinical Nutrition, St James Hospital, Dublin, Ireland.
Magnhild KvernelandNational Center for Epilepsy, Member of the ERN EpiCARE, Oslo University Hospital, Oslo, Norway.ORCID https://orcid.org/0000-0003-1778-0835
Elles van der LouwDivision of Dietetics, Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.ORCID https://orcid.org/0000-0003-3245-0471
Mengyang LuInstitute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Martina P ZanaboniChild Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Full Member of European Reference Network EpiCARE, Pavia, Italy.ORCID https://orcid.org/0000-0003-4902-3126
Marisa ArmenoMetabolic Research Center, Department of Clinical Nutrition, Buenos Aires, Argentina.ORCID https://orcid.org/0000-0002-6776-6380
Elizabeth A FeltonDepartment of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.ORCID https://orcid.org/0000-0001-6461-5758

Funding

QAQC Johns Hopkins Institute for Clinical and Translational ResearchUL1TR003098 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2019 to 2023
$57.7M
NCATS NIH HHS UL1 TR003098
6 · The paper itself

Abstract

objectiveKetogenic diet therapies (KDTs) are increasingly used as a treatment for people with epilepsy of childbearing potential (PWECP) and glucose transporter type 1 deficiency syndrome (Glut1DS). The aim of this study was to collect information on clinical experience with KDT during pregnancy and lactation in these populations.

methodsBetween December 2023 and June 2024, an online survey was widely circulated to healthcare professionals (HCPs) working with PWECP and people with Glut1DS of childbearing potential on KDT. The survey explored KDT use during pregnancy and lactation. Only HCPs working with patients who expressed interest in KDT and who were planning to become pregnant or were already pregnant were invited to complete the survey.

resultsThirty-five HCPs had counseled patients about whether to follow KDT during pregnancy. Sixty percent of HCPs did not recommend KDT during pregnancy. Key concerns included a lack of expertise with KDT use during pregnancy, insufficient data on the safety of KDT use during pregnancy, and uncertainty about the impact on fetal development. Among the HCPs (40%) who recommended KDT during pregnancy, there was no consensus regarding the version of KDT or optimal macronutrient composition. Even fewer HCPs (n = 5) had provided counseling on diet adaptation during lactation. Low Glycemic Index Treatment and the modified Atkins diet were most recommended. Blood ketone monitoring was unanimously recommended during lactation. SIGNIFICANCE: Based on the survey results, HCPs have variable opinions about the safety, management, ideal diet, and levels of ketosis for people with epilepsy (PWE) and Glut1DS on KDT during pregnancy and lactation. There was consensus about monitoring ketosis levels and ensuring micronutrient supplementation. Patient enrollment in pregnancy registries that capture KDT use is crucial to support future research and expand knowledge about the safety of KDT so HCPs and PWE or Glut1DS can make informed decisions about their treatment. PLAIN LANGUAGE SUMMARY: Most healthcare providers (HCPs) did not advise ketogenic diet therapy (KDT) for epilepsy during pregnancy, though some noted exceptions for glucose transporter type 1 deficiency syndrome. Their main concerns were not having enough information about safety for the parent and fetus and their own lack of experience using KDT during pregnancy. The 40% of HCPs who supported the use of KDT during pregnancy stressed the need for personalized care and close monitoring to reduce risks. Few HCPs have used KDT during lactation. Experts advised using more flexible versions of KDT during lactation. More research is needed.

Indexed as

Attitude of Health PersonnelCarbohydrate Metabolism, Inborn ErrorsDiet, KetogenicEpilepsyLactationPregnancy ComplicationsAdultFemaleHealth PersonnelHumansMonosaccharide Transport ProteinsPregnancySurveys and QuestionnairesMonosaccharide Transport Proteinsbreastfeedingchildbearing potentialclassic ketogenic dietGlut1DSketogenic metabolic therapyketonesketosislow glycemic index treatmentmodified Atkins diet

Identifiers

PMID40439278
PMCPMC12362179

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

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.