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

IF 2.8 3区 医学 Q2 CLINICAL NEUROLOGY
Epilepsia Open Pub Date : 2025-05-29 DOI:10.1002/epi4.70067
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, Martina P Zanaboni, Marisa Armeno, Elizabeth A Felton
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Abstract

Objective: Ketogenic 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.

Methods: Between 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.

Results: Thirty-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.

生酮饮食治疗妊娠和哺乳期癫痫:一项探讨临床医生观点的国际调查。
目的:生酮饮食疗法(KDTs)越来越多地被用于治疗生育潜能癫痫(PWECP)和葡萄糖转运蛋白1型缺乏综合征(Glut1DS)患者。本研究的目的是收集这些人群妊娠和哺乳期KDT的临床经验信息。方法:在2023年12月至2024年6月期间,在PWECP工作的医疗保健专业人员(HCPs)和KDT生育潜力的Glut1DS患者中广泛分发在线调查。该调查探讨了妊娠期和哺乳期KDT的使用情况。只有那些对KDT感兴趣、计划怀孕或已经怀孕的患者的医护人员才被邀请完成调查。结果:35名HCPs咨询了患者是否在怀孕期间遵循KDT。60%的HCPs不建议怀孕期间使用KDT。主要问题包括缺乏怀孕期间使用KDT的专业知识,怀孕期间使用KDT的安全性数据不足,以及对胎儿发育影响的不确定性。在怀孕期间推荐KDT的HCPs(40%)中,对于KDT的版本或最佳常量营养素组成没有达成共识。更少的HCPs (n = 5)在哺乳期提供饮食适应咨询。低血糖指数治疗和改良阿特金斯饮食是最推荐的。一致建议在哺乳期进行血酮监测。意义:根据调查结果,HCPs对妊娠和哺乳期癫痫患者(PWE)和glutds的KDT的安全性、管理、理想饮食和酮症水平有不同的看法。在监测酮症水平和确保微量营养素补充方面达成了共识。记录KDT使用情况的患者妊娠登记对于支持未来的研究和扩大KDT安全性的知识至关重要,因此HCPs和PWE或Glut1DS可以对其治疗做出明智的决定。简单的语言总结:大多数医疗保健提供者(HCPs)不建议生酮饮食疗法(KDT)用于妊娠癫痫,尽管一些注意到葡萄糖转运蛋白1型缺乏综合征的例外。他们主要担心的是没有足够的关于父母和胎儿安全的信息,以及他们自己在怀孕期间缺乏使用KDT的经验。40%支持怀孕期间使用KDT的医护人员强调需要个性化护理和密切监测以降低风险。很少有医护人员在哺乳期使用KDT。专家建议在哺乳期使用更灵活的KDT。需要更多的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Epilepsia Open
Epilepsia Open Medicine-Neurology (clinical)
CiteScore
4.40
自引率
6.70%
发文量
104
审稿时长
8 weeks
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