Women with epilepsy during pregnancy: A systematic review of current guidelines

Objective

To systematically evaluate the quality of existing guidelines for the management of pregnancy in women with epilepsy (WWE) and compare their key recommendations.

Methods

A systematic review of available clinical practice guidelines and expert consensus statements was conducted. The quality of the literature was assessed using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Core information was extracted using a predefined form and subjected to comparative analysis.

Results

Only 14 guidelines on WWE pregnancy management have been published worldwide. Most guidelines performed well in scope definition, clarity of purpose, and presentation, but the evidence base was relatively weak. Recommendations were largely consistent across guidelines regarding preconception counseling, folic acid supplementation, vaginal delivery, breastfeeding, and avoidance of valproate. However, discrepancies were observed in the selection of certain antiseizure medications (ASMs), therapeutic drug monitoring, and the timing and dosage of folic acid supplementation. Current guidelines lack recommendations on newer ASMs and antinociceptive management during delivery.

Conclusion

The variability in recommendations among WWE pregnancy management guidelines reflects the insufficiency of the existing evidence base, highlighting the need for enhanced methodological rigor in guideline development and more comprehensive, evidence-based recommendations. Establishing large-scale prospective pregnancy registries is critical for improving WWE pregnancy management guidelines.