Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Jukka Peltola, Tampere University Hospital, Finland
- Second opponent: Adjunctive professor Eva Kumlien, Uppsala Universitet, Sweden
- Third member and chair of the evaluation committee: Professor John-Anker Zwart, University of Oslo
Chair of the Defence
Professor Emeritus Leif Gjerstad, University of Oslo
Principal Supervisor
Professor Morten Ingvar Lossius, National Centre for epilepsy, Norway
Summary
Epilepsy in women of childbearing age may be challenging due to potential harm posed by antiepileptic drugs and issues regarding contraception and fertility. Anette Huuse Farmen has studied birth rates, intrauterine growth, obstetric complications and pharmacokinetics in women with epilepsy. Data from the Oppland Perinatal Database and a therapeutic drug-monitoring database at the National Centre for Epilepsy was used to study pregnant women with validated and classified epilepsy.
Fewer young women with epilepsy used birth control pills and average age at first birth was lower. Birthrates among the youngest women with epilepsy were equivalent to women without epilepsy, while birth¬rates above 25 years were low.
Women with epilepsy had a higher risk of undergoing acute cesarean section and the child being in breech position than both women with other chronic diseases and healthy women. Children of mothers with epilepsy were smaller in foetal life compared to others. Foetal exposure of epilepsy medicine increased the risk. Epileptic seizures did not affect the risk of complications.
The total valproate concentration in blood varied up to 13-fold between women taking the same dose, and the concentration/dose ratio of total valproate decreased as the pregnancy progressed. Despite documented risk of fetal harm, few analysis of the active, free valproate concentration were conducted. The proportions of free valproate remained unchanged or increased during pregnancy.
Although many women with epilepsy experience uncomplicated pregnancy and delivery, there is a need for interdisciplinary follow-up in women with epilepsy of childbearing age. Healthcare professionals should provide guidance regarding contraception and family planning, and both total and free valproate should be measured. Possible consequences of reduced foetal growth and reasons for acute caesarean section among women with epilepsy should be further investigated.
Additional information
Contact the research support staff.