Pregnancy

http://www.semanticweb.org/administrator/ontologies/2022/0/untitled-ontology-34#OWLClassac85ad9b_de81_4bcf_b9fd_6ea4b49a2e69

大部分癫痫产妇都能正常分娩，但疼痛、压力、情绪过度紧张、睡眠不足、过度换气等因素均可增加分娩期癫痫发作的危险，建议患者到有条件的医院生产。 "关于成人癫痫患者长程管理的专家共识." 中华神经科杂志 .07(2013):496-499.

在妊娠前，应保证至少最近半年无癫痫发作。 中国医师协会神经内科分会癫(癎)专委会. "妊娠期女性抗癫(癎)药物应用中国专家共识." 中国医师杂志 17.7(2015):969-971. 如果患者最近两至三年均无发作，且脑电图正常，在告知癫痫复发对患者及胎儿的影响后，可以考虑逐步停药。否则，应当对病情进行综合评估，并依据患者的癫痫发作类型，选取最小剂量AEDs控制发作，并尽可能采取单药治疗方案。 中国医师协会神经内科分会癫(癎)专委会. "妊娠期女性抗癫(癎)药物应用中国专家共识." 中国医师杂志 17.7(2015):969-971. 强直-阵挛性发作可导致胎儿心动过缓、缺氧甚至流产。 中国医师协会神经内科分会癫(癎)专委会. "妊娠期女性抗癫(癎)药物应用中国专家共识." 中国医师杂志 17.7(2015):969-971. 女性癫痫患者发生毒血症、重度子痫、胎盘出血、早产等并发症的概率是正常女性的3倍，围产儿死亡率可升高2倍。 中国医师协会神经内科分会癫(癎)专委会. "妊娠期女性抗癫(癎)药物应用中国专家共识." 中国医师杂志 17.7(2015):969-971. 对于分娩期间出现剧烈呕吐无法服药的患者，可暂予注射苯妥英钠替代口服以控制发作。 对于之前已经口服苯妥英钠的患者，可予相同剂量苯妥英钠分次静脉注射；若患者之前服用其他AEDs，可给予苯妥英钠15～20mg/kg负荷剂量静脉注射后，再给予8mg／(kg·d) 的剂量分两次维持(≤25mg／min)，同时需严密监测患者发作情况。 若患者漏服AEDs>12h，应立即就诊，必要时可考虑苯妥英钠注射。 中国医师协会神经内科分会癫(癎)专委会. "妊娠期女性抗癫(癎)药物应用中国专家共识." 中国医师杂志 17.7(2015):969-971. 绝大多数女性癫痫患者可经阴道顺产。 约2％-4％的女性患者在分娩过程中或分娩后24h内会出现强直-阵挛性发作，从而导致母体和胎儿缺氧，应立即予10～20mg安定缓慢静脉注射终止发作，必要时按癫痫持续状态处理。 中国医师协会神经内科分会癫(癎)专委会. "妊娠期女性抗癫(癎)药物应用中国专家共识." 中国医师杂志 17.7(2015):969-971.

生育期：重视癫痫女性的生育机能是提高患者生活质量的重要环节之一。对于尚未生育的患者应尽量避免使用可能影响生育功能的药物，如丙戊酸类药物；建议准备生育的患者在医生的指导下计划妊娠。 Li, S. and Hong, Z., 2015. Lin chuang zhen liao zhi nan. Beijing: Ren min wei sheng chu ban she. 妊娠：孕妇除定期进行产科检查外，还应定期就诊于癫痫专科医生；根据临床发作情况及时调整AEDs的剂量，尽量减少和避免发作，尤其是全面性强直-阵挛发作。孕妇也需要了解，没有证据表明局灶性、失神以及肌阵挛性发作会影响妊娠期与发育阶段的胎儿，除非患者跌倒或者受到了伤害；如果妊娠期间发作控制不佳，要充分考虑到妊娠相关因素的影响，如剧烈呕吐、依从性差等；妊娠16-20周时应该对胎儿进行详细的超声波检查，及时发现可能存在的畸形。 Li, S. and Hong, Z., 2015. Lin chuang zhen liao zhi nan. Beijing: Ren min wei sheng chu ban she.

妊娠期抗癫痫治疗

Recommendations for delivery, post-partum, and breastfeeding 应告知患者产后癫痫发作的风险，如果患者在分娩时没有进行治疗，应在分娩期间或产后立即开始治疗。VPA静脉负荷（intravenous valproate loading）可能是必要的。只有在VPA是唯一合适的选择并且没有再次妊娠的计划的情况下，才应该重新采用VPA作为长期治疗。 专家小组建议进行母乳喂养，但应权衡婴儿不良反应，同时应监测婴儿的不良反应（如嗜睡、喂养困难、呕吐和瘀斑）。 新生儿出生时和1岁以下应仔细筛查MCMs，宫内暴露于VPA的儿童也应评估是否存在发育迟缓，并建议早期干预。 Women should be informed of the risk of post-partum seizures. If a patient is not on treatment at the time of delivery, treatment should be initiated during delivery or in the immediate post-partum period to reduce the risk of seizure. Intravenous valproate loading may be necessary. Valproate should only be reintroduced as long-term therapy, if it is the only suitable option and no further pregnancies are planned. Breastfeeding is recommended, but its compatibility with treatment must be assessed on a case-by-case basis. The benefits of breastfeeding during valproate treatment should be weighed against the slight risk of undesirable effects in the infant. Check-up visits to monitor for such effects (e.g., drowsiness, difficulty feeding, vomiting, and petechiae) are essential. Newborns should be carefully screened for MCMs at birth and up to 1 year of age. Children exposed to valproate in utero should also be assessed for developmental delay and referred for early intervention. Toledo M, Mostacci B, Bosak M, Jedrzejzak J, Thomas RH, Salas-Puig J, Biraben A, Schmitz B. Expert opinion: use of valproate in girls and women of childbearing potential with epilepsy: recommendations and alternatives based on a review of the literature and clinical experience-a European perspective. J Neurol. 2020 Apr 1. doi: 10.1007/s00415-020-09809-0. Epub ahead of print. PMID: 32239268. Recommendations for valproate switching and discontinuation in IGE VPA换药和停药的关键时期时青春期前、月经初潮时和怀孕前。专家小组认为，在患者10岁左右（月经初潮前）应推荐患者更换VPA为其他AEDs。对于VPA治疗有效的育龄期患者，可以停用、减量或与拉莫三嗪/左乙拉西坦联合使用，从而减少VPA用量。VPA换药应在怀孕前一年开始，换药速度应视具体情况决定。当患者体内已清除VPA（上次服药后1个月）、没有癫痫发作（基于癫痫复发风险，无发作时间为之前癫痫发作间隔的3倍）时可以考虑尝试怀孕。新的AEDs的剂量调整应基于临床特征，为了平衡有效性和药物耐受性，建议至少3个月。 Valproate switching and discontinuation generally occurs at certain relevant life stages. The three crucial periods are before puberty, at menarche, and before pregnancy. Valproate switching or discontinuation should be recommended in pre-menarche patients (around 10 years of age) after discussion of relevant issues with the patient and her parents/legal guardians. Family planning should be discussed with adult patients of childbearing potential. In patients responsive to valproate only, it could be discontinued, reduced, or combined with lamotrigine or levetiracetam, thus reducing valproate dosage. Valproate switching should ideally be started about 1 year ahead of pregnancy. The speed with which the switch is made, however, should be decided on a case-by-case basis depending on how strong the woman’s desire is to become pregnant. Following valproate discontinuation, patients should not try to conceive until (1) their body is clear of valproate (at least 1 month since last intake) and (2) they are free of seizures (based on seizure recurrence risk, three times the previous interval between seizures). Dose adjustments for the new AED should be based on clinical features; a period of at least 3 months is recommended for balancing efectiveness and tolerability. Toledo M, Mostacci B, Bosak M, Jedrzejzak J, Thomas RH, Salas-Puig J, Biraben A, Schmitz B. Expert opinion: use of valproate in girls and women of childbearing potential with epilepsy: recommendations and alternatives based on a review of the literature and clinical experience-a European perspective. J Neurol. 2020 Apr 1. doi: 10.1007/s00415-020-09809-0. Epub ahead of print. PMID: 32239268.

Pregnancy

The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.

The state or condition of having a developing embryo or fetus in the body (uterus), after union of an ovum and spermatozoon, during the period from conception to birth.

The clinician should discuss with the woman and girl the relative benefits and risks of adjusting medication to enable her to make an informed decision. Where appropriate, the woman or girl's specialist should be consulted. [2004] 临床医生应与女性癫痫患者讨论调整药物的相对益处和风险，以使她能够做出明智的决定。在适当的情况下，应咨询该女性的专科医生。 Women and girls should be reassured that an increase in seizure frequency is generally unlikely in pregnancy or in the first few months after birth. [2004] 应该让女性患者放心，在怀孕期间或分娩后的最初几个月，癫痫发作频率通常不太可能增加。 [2004] Care of pregnant women and girls should be shared between the obstetrician and the specialist. [2004] 孕妇的护理应由产科医生和专科医生共同承担。 [2004] Pregnant women and girls who are taking AEDs should be offered a high-resolution ultrasound scan to screen for structural anomalies. This scan should be performed at 18–20 weeks' gestation by an appropriately trained ultrasonographer, but earlier scanning may allow major malformations to be detected sooner. [2004] 应为服用 抗癫痫药物的女性提供高分辨率超声扫描以筛查结构异常。该扫描应由受过规范培训的超声医师在妊娠 18-20 周时进行，但早期扫描可以更快地发现主要畸形。 [2004] Aim for seizure freedom before conception and during pregnancy (particularly for women and girls with generalised tonic–clonic seizures) but consider the risk of adverse effects of AEDs and use the lowest effective dose of each AED,avoiding polytherapy if possible. [new 2012] 应以在受孕前和怀孕期间无癫痫发作为目标（特别是对于全面强直-阵挛发作的女性），但要考虑抗癫痫药物的不良反应风险，并使用每种抗癫痫药物的最低有效剂量，以尽可能避免多药治疗。 [2012年新] All women and girls on AEDs should be offered 5 mg per day of folic acid before any possibility of pregnancy.[2004] 所有服用抗癫痫药物的女性在任何可能怀孕的机会前都应每日补充5mg的叶酸。 Do not routinely monitor AED levels during pregnancy. If seizures increase or are likely to increase, monitoring AED levels (particularly levels of lamotrigine and phenytoin, which may be particularly affected in pregnancy) may be useful when making dose adjustments. [new 2012] 怀孕期间不要常规监测抗癫痫药物水平。如果癫痫发作增加或可能增加，监测 AED 水平（尤其是拉莫三嗪和苯妥英的水平，其在怀孕期间可能受到特别影响）在调整剂量时可能有用。 [2012年新] Women and girls with epilepsy should be informed that although they are likely to have healthy pregnancies, their risk of complications during pregnancy and labour is higher than for women and girls without epilepsy. [2004] 应告知女性癫痫患者，尽管她们的妊娠可能是正常的，但她们在怀孕和分娩期间发生并发症的风险高于未患癫痫的其他女性。 [2004] All pregnant women and girls with epilepsy should be encouraged to notify their pregnancy, or allow their clinician to notify the pregnancy, to the UK Epilepsyand Pregnancy Register. [2004] 应鼓励所有患有癫痫症的孕妇和女孩向英国癫痫和妊娠登记处报告怀孕，或允许其临床医生向英国癫痫和妊娠登记处报告怀孕。 Women and girls with epilepsy need accurate information during pregnancy,and the possibility of status epilepticus and SUDEP should be discussed with all women and girls who plan to stop AED therapy (see section 1.9.18). [2004] 女性癫痫患者在怀孕期间需要准确的信息，也应当告知所有计划停止抗癫痫药物治疗的女性有关持续癫痫与癫痫猝死的可能性。 Generally, women and girls may be reassured that the risk of a tonic–clonic seizure during the labour and the 24 hours after birth is low (1–4%). [2004] 一般来说，女性患者可以放心，在分娩期间和孩子出生后 24 小时内发生强直-阵挛性发作的风险很低（1-4%）。 [2004] Discuss with women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), and their parents and/or carers if appropriate, the risk of AEDs causing malformations and possible neurodevelopmental impairments in an unborn child. Assess the risks and benefits of treatment with individual drugs. There are limited data on risks to the unborn child associated with newer drugs. Specifically discuss the risk of continued use of sodium valproate to the unborn child, being aware that higher doses of sodium valproate (more than 800 mg/day) and polytherapy, particularly with sodium valproate, are associated with greater risk.[new2012] 请告知有生育潜力的女性患者（包括可能需要治疗至育龄期的年轻女孩）及她们的父母和/或照料人有关抗癫痫药物（AEDs）对胎儿的致畸和引起神经发育障碍的风险。并请评估使用特定药物治疗的风险与益处。目前新药对胎儿的风险数据较少。请特别讨论持续使用丙戊酸钠对未出生的孩子的风险，注意更高剂量的丙戊酸钠（超过 800 毫克/天）和综合疗法（特别是使用了丙戊酸钠时）可能与更大的风险有关。 nice.org.uk/guidance/cg137

Pregnancy

What are the risks of obstetric complications in pregnant WWE, including those taking AEDs? 妊娠期WWE（包括服用AEDs者）发生产科并发症的风险 [GRADES OF RECOMMENDATION:B] Healthcare professionals need to be aware of the small but significant increase in obstetric risks to WWE and those exposed to AEDs, and to incorporate this in the counselling of women and the planning of management. 【推荐等级：B】WWE和暴露于AEDs的患者发生产科并发症的风险增加（small but significant），应将这些风险考虑到患者咨询和管理计划中。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What other conditions in pregnancy should be considered in the differential diagnosis of epileptic seizures? 癫痫的鉴别诊断在妊娠期需要考虑什么？ In pregnant women presenting with seizures in the second half of pregnancy which cannot be clearly attributed to epilepsy, immediate treatment should follow existing protocols for eclampsia management until a definitive diagnosis is made by a full neurological assessment. 对于在妊娠后半段出现痫性发作且无法归因于癫痫的孕妇，应立即按照子痫进行紧急处理，直到有全面的神经病学评估作出明确诊断。 Other cardiac, metabolic and intracranial conditions should be considered in the differential diagnosis. Neuropsychiatric conditions including non-epileptic attack disorder should also be considered. 鉴别诊断时应考虑心脏、代谢和颅内疾病以及神经精神疾病（包括非痫性发作在内）。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

How should women with non-epileptic attack disorder be counselled in pregnancy and how should their non-epileptic seizures be managed? 患有非痫性发作障碍（non-epileptic attack disorder）的妇女在妊娠期应如何处理 [GRADES OF RECOMMENDATION:D] Inappropriate medical intervention, including AED administration and iatrogenic early delivery, should be avoided when there is a firm diagnosis of non-epileptic attack disorder. 【推荐等级：D】对于确诊非痫性发作障碍时，应避免不适当的医疗干预，包括AEDs和医源性早产。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What is the effect of pregnancy on seizures in WWE? 对于WWE而言，妊娠对于癫痫发作有何影响？ [GRADES OF RECOMMENDATION:C] WWE should be informed that two-thirds will not have seizure deterioration in pregnancy. 【推荐等级：C】应告知WWE，2/3的患者在妊娠期不会出现癫痫发作恶化。 [GRADES OF RECOMMENDATION:D] Pregnant women who have experienced seizures in the year prior to conception require close monitoring for their epilepsy.（evidence level 2-：In women who were seizure free for at least 9 months to 1 year prior to pregnancy, 74–92% continued to be seizure free in pregnancy.） 【推荐等级：D】在孕前1年内有癫痫发作的孕妇需要在妊娠期密切监测其癫痫发作情况。（2-证据显示，在孕前至少9个月到1年没有癫痫发作的妇女中，74%-92%的妇女在妊娠期没有癫痫发作） https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What are the recommended models for antenatal care of WWE and what are the benefits of joint obstetrics and neurology clinics? WWE产前护理推荐模式 Pregnant WWE should have access to regular planned antenatal care with a designated epilepsy care team. 妊娠期WWE应与指定的癫痫护理小组共同制定定期的产前护理计划。 All pregnant WWE should be provided with information about the UK Epilepsy and Pregnancy Register and invited to register. 建议所有妊娠期WWE进行登记。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What may affect the driving entitlements of WWE who are pregnant? 1.1影响妊娠期WWE驾驶的因素 WWE should be informed of the effect of changing the dose of AED on seizures and its impact on driving privileges. 1.1.1应告知WWE改变AEDs剂量对其癫痫发作的影响和对驾驶的影响。（妊娠期减少AEDs剂量可能会导致癫痫发作恶化，这对其是否能够驾驶会产生不利影响。） https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What are the long-term neurodevelopmental outcomes of exposure to AEDs and maternal seizure in infants born to WWE? 宫内暴露于AEDs对胎儿长期神经发育的影响 [GRADES OF RECOMMENDATION:C] WWE and their partners need to be informed about the possible adverse impact on long-term neurodevelopment of the newborn following in utero exposure to sodium valproate. 【推荐等级：C】应告知WWE及其伴侣，宫内暴露于VPA可能对其长期神经发育产生不利影响。 [GRADES OF RECOMMENDATION:C] Based on limited evidence, in utero exposure to carbamazepine and lamotrigine does not appear to adversely affect neurodevelopment of the offspring. There is very little evidence for levetiracetam and phenytoin. Parents should be informed that evidence on long-term outcomes is based on small numbers of children. 【推荐等级：C】应告知WWE及其伴侣，关于宫内暴露于AEDs产生的长期神经发育结果是基于少数儿童的。有限的证据表示，宫内接触CBZ和LTG似乎不会影响后代神经生长发育；使用LEV和PHT的证据很少。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What are the risks of congenital malformations in the fetus of pregnant women with epilepsy (WWE) exposed and not exposed to antiepileptic drugs (AEDs)? 宫内暴露于AEDs对胎儿先天畸形的影响 WWE who are planning their pregnancy should have a clinician competent in the management of epilepsy take responsibility for sharing decisions around choice and dose of AEDs, based on the risk to the fetus and control of seizures. 计划怀孕的WWE应由一位临床医生负责处理其癫痫发作、控制AEDs剂量。 [GRADES OF RECOMMENDATION:C] WWE should be reassured that most mothers have normal healthy babies and the risk of congenital malformations is low if they are not exposed to AEDs in the periconception period. 【推荐等级：C】应告知WWE，多数WWE母亲可拥有正常健康的婴儿，如果WWE在围妊娠期不接触AEDs，其后代发生先天畸形的风险很小。 [GRADES OF RECOMMENDATION:B] Women should be informed that the risk of congenital abnormalities in the fetus is dependent on the type, number and dose of AEDs. 【推荐等级：B】应告知WWE，胎儿先天畸形的风险取决于AEDs的类型、数量和剂量。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

To what extent can congenital abnormalities be minimised in WWE? 先天畸形的发生在WWE后代中可以控制到什么程度？ All WWE should be advised to take 5 mg/day of folic acid prior to conception and to continue the intake until at least the end of the first trimester to reduce the incidence of major congenital malformation. 建议所有WWE在孕前补充叶酸5mg/d，至少持续到妊娠早期，以减少MCMs发生率。 [GRADES OF RECOMMENDATION:C] Prepregnancy folic acid 5 mg/day may be helpful in reducing the risk of AED-related cognitive deficits. 【推荐等级：C】孕前补充5mg/d叶酸可能可以降低AEDs相关认知障碍的风险。 [GRADES OF RECOMMENDATION:B] The lowest effective dose of the most appropriate AED should be used. 【推荐等级：B】妊娠期WWE应选用适宜的最低有效剂量的AEDs。 Exposure to sodium valproate and other AED polytherapy should be minimised by changing the medication prior to conception, as recommended by an epilepsy specialist after a careful evaluation of the potential risks and benefits. 孕前使用VPA和其他AEDs综合治疗的患者，应根据癫痫专家的评估和建议下，在孕前即更换药物，以最大限度减少风险。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

Women with a history of epilepsy who are not considered to have a high risk of unprovoked seizures can be managed as low-risk women in pregnancy. 对于有癫痫病史的妇女，如果不具有非诱发性癫痫发作（unprovoked seizures）的高风险，可以作为低风险病例进行妊娠期的管理。 The rates of seizure deterioration in pregnancy may be associated with the type of seizure.Uncontrolled tonic-clonic seizures are the strongest risk factor for SUDEP, which are the main cause of death in pregnant WWE.（SUDEP is defined as ‘sudden, unexpected, witnessed or unwitnessed, nontraumatic and nondrowning death in patients with epilepsy, with or without evidence for a seizure and excluding documented status epilepticus, in which postmortem examination does not reveal a toxicologic or anatomic cause for death.） 妊娠期癫痫发作恶化的比例与癫痫发作类型有关。GTCS是SUDEP的最大危险因素，是妊娠期WWE死亡的主要原因。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

How should risks be communicated to WWE? 如何向WWE交代风险？ WWE should be provided with verbal and written information on prenatal screening and its implications, the risks of self-discontinuation of AEDs and the effects of seizures and AEDs on the fetus and on the pregnancy, breastfeeding and contraception. 应向WWE提供有关产前筛查的相关信息和自行停用AEDs、癫痫发作的风险以及AEDs对胎儿、怀孕、哺乳和避孕的影响，这之中应包括口头和书面信息。 WWE should be informed that the introduction of a few safety precautions may significantly reduce the risk of accidents and minimise anxiety. 应告知WWE，引入一些安全预防措施可以显著降低事故风险和孕产妇焦虑. [GRADES OF RECOMMENDATION:D] Healthcare professionals should acknowledge the concerns of WWE and be aware of the effect of such concerns on their adherence to AEDs. 【推荐等级：D】医护人员应认识到WWE的担忧，这种担忧可能影响WWE的依从性。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What is the optimum method and timing of screening for detection of fetal abnormalities? 筛查胎儿先天畸形的最佳方法和时机 Early pregnancy can be an opportunity to screen for structural abnormalities. The fetal anomaly scan at 18+0–20+6 weeks of gestation can identify major cardiac defects in addition to neural tube defects. 早期妊娠（early pregnancy）是筛查胎儿结构异常的机会。妊娠18+0-20+6周除了可发现胎儿神经管缺损外，还可发现心脏缺损。 [GRADES OF RECOMMENDATION:D] All WWE should be offered a detailed ultrasound in line with the National Health Service Fetal Anomaly Screening Programme standards. 【推荐等级：D】应向所有WWE提供符合国家卫生服务胎儿异常筛查计划标准（National Health Service Fetal Anomaly Screening Programme standards）的详细超声检查。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

Where required, what dose of antenatal corticosteroids should be given to WWE on enzyme-inducing AEDs? 对于服用酶诱导AEDs的WWE，在需要的情况下，应在产前如何给予皮质类固醇？ [GRADES OF RECOMMENDATION:D] In WWE taking enzyme-inducing AEDs who are at risk of preterm delivery, doubling of the antenatal corticosteroid dose for prophylaxis against respiratory distress syndrome in the newborn is not recommended. 【推荐等级：D】对于有早产风险的服用酶诱导AEDs的WWE，不建议增加产前用于预防新生儿呼吸窘迫综合征的皮质类固醇剂量。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What are the adverse effects of AEDs in pregnancy on the mother and how can they be minimised? 妊娠期使用AEDs对母亲的不利影响是什么？如何控制？ [GRADES OF RECOMMENDATION:D] Healthcare professionals should be alert to signs of depression, anxiety and any neuropsychiatric symptoms in mothers exposed to AEDs. 【推荐等级：D】医务人员应警惕用药过程中WWE出现的抑郁、焦虑和任何神经精神症状。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What is the optimal timing and mode of delivery for WWE based on seizure control? WWE最佳生产方式和时机是什么？ WWE should be reassured that most will have an uncomplicated labour and delivery. 应告知WWE，多数WWE都可经历顺利的分娩过程（uncomplicated labour and delivery）。 [GRADES OF RECOMMENDATION:D] The diagnosis of epilepsy per se is not an indication for planned caesarean section or induction of labour. 【推荐等级：D】癫痫并不是择期剖腹产或引产的适应症。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

Women with epilepsy who are pregnant or who have recently been pregnant and who require hospital admission should not be placed in a single room. 住院的妊娠期女性癫痫患者不应被安置在单间病房中。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

Wherever possible sodium valproate should be avoided during pregnancy.For women of childbearing potential, particularly those women contemplating pregnancy, other antiepileptic drugs should be considered in preference to sodium valproate. However, sodium valproate might be the only effective antiepileptic drug for some women, and this should not preclude its use. 妊娠期间应尽可能避免使用VPA或包括VPA在内的综合治疗方案。对于育龄期女性，尤其是有计划怀孕的女性，应优先考虑除了VPA以外的AEDs（但在某些不得不使用VPA的情况下，仍应使用VPA）。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

Any woman with epilepsy who has given birth to a child with a congenital malformation while taking an antiepileptic drug should be offered review by an obstetrician and an epilepsy specialist before any future pregnancy. 对于任何女性癫痫患者，如果在服用AEDs时生下了患有先天畸形的孩子，在未来怀孕之前应由产科医师和癫痫专家进行评估。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

[GRADES OF RECOMMENDATION:B] Women with epilepsy should: receive prepregnancy counselling at the time of diagnosis and at regular intervals during their management, especially if they are taking antiepileptic drug treatment. B级推荐：女性癫痫患者在确诊时和治疗期间应定期接受孕前咨询，尤其是在接受AEDs治疗时。 [GRADES OF RECOMMENDATION:D] be reassured that most will have a normal pregnancy and delivery D级推荐：应告知女性癫痫患者，多数都可经历正常的妊娠和分娩。 [GRADES OF RECOMMENDATION:C] have their diagnosis and treatment, if appropriate, reviewed by specialist services before conception; a concerted effort should be made to optimise seizure control and rationalise antiepileptic drug therapy prior to conception C级推荐：在适当的情况下，在受孕前应由相关领域的专家再次评估其诊断和治疗的准确性和合理性；受孕前应优化治疗以控制癫痫发作。 [GRADES OF RECOMMENDATION:D] be well informed about pregnancy and epilepsy-related issues, including smoking cessation,before conception. D级推荐：女性癫痫患者在怀孕前应充分了解怀孕和癫痫相关的问题，并戒烟。 [GRADES OF RECOMMENDATION:C] Women with epilepsy trying to conceive or who present in the first trimester should be advised to take folic acid during this time to reduce the risk of major congenital malformations. C级推荐：女性癫痫患者在妊娠早期应服用叶酸以降低MCMs风险。 [GRADES OF RECOMMENDATION:D] Women receiving sodium valproate should be advised that folic acid supplementation may reduce the rate of spontaneous miscarriage. D级推荐：接受VPA治疗的妇女补充叶酸可降低自然流产率。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

[GRADES OF RECOMMENDATION:D] Pregnant women with epilepsy should be made aware of the risks of uncontrolled seizures both to themselves and to their developing fetus. D级推荐：应告知女性癫痫患者不受控制的癫痫发作对患者和发育中的胎儿都有危险。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

A detailed assessment of fetal anatomy to detect fetal congenital abnormalities should be offered to all pregnant women with epilepsy at 18–20 weeks gestation. 所有妊娠18-20周的女性癫痫患者都应进行详细的胎儿解剖学（fetal anatomy）评估以发现胎儿先天异常。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

[GRADES OF RECOMMENDATION:D] All infants of women with epilepsy should be offered vitamin K1,1 mg intramuscularly at birth,unless there are contraindications. D级推荐：在没有禁忌证的情况下，所有女性癫痫患者的产儿在出生时都应肌肉注射注射1mg VitK1。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

[GRADES OF RECOMMENDATION:D] As good seizure control during pregnancy is more likely in women whose seizures are controlled prior to becoming pregnant an effort should be made to optimise seizure control prior to pregnancy(particularly for generalised tonic-clonic seizures). D级推荐：在怀孕前即控制癫痫发作的女性癫痫患者更可能在妊娠期达到控制癫痫发作，所以应在怀孕前优化治疗（尤其是对于全身强直-阵挛发作）。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

For most patients, reassurance can be given that, in general, the risk of epilepsy developing in the children of parents with epilepsy is low. 应告知患者，对于大多数癫痫患者而言，其后代患癫痫的风险很低。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

Given the morbidity and mortality risks associated with seizures (including sudden unexpected death in epilepsy) no antiepileptic drug should be discontinued during pregnancy unless this has been discussed with an epilepsy specialist. 考虑到与癫痫发作相关的发病率和死亡率（包括SUDEP），妊娠期不应停止使用任何AEDs。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

多数WWE可经历健康的妊娠和分娩并拥有健康的生产结局，其癫痫发作的频率通常在妊娠期和产褥期保持不变（Level Ⅱ）。 Most WWE experience uneventful pregnancies and normal deliveries of healthy offspring. Frequency of ES usually remains unchanged during pregnancy, childbirth, or puerperium (LE II). Mauri Llerda JA, Suller Marti A, de la Peña Mayor P, Martínez Ferri M, Poza Aldea JJ, Gomez Alonso J, Mercadé Cerdá JM. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients. Neurologia. 2015 Oct;30(8):510-7. English, Spanish. doi: 10.1016/j.nrl.2014.08.002. Epub 2015 Jan 21. PMID: 25618222. 推荐阴道分娩。 Vaginal delivery is recommended. Mauri Llerda JA, Suller Marti A, de la Peña Mayor P, Martínez Ferri M, Poza Aldea JJ, Gomez Alonso J, Mercadé Cerdá JM. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients. Neurologia. 2015 Oct;30(8):510-7. English, Spanish. doi: 10.1016/j.nrl.2014.08.002. Epub 2015 Jan 21. PMID: 25618222. 若患者发生GTCS的风险较高（1%-3%）或者复杂部分性发作时间过长/过于频繁导致难产，可以考虑剖腹产。 Caesarean delivery can be considered in cases of high risk of GTCS (1%-3%), or if prolonged or frequent CPS make it difficult for the woman to labour. Mauri Llerda JA, Suller Marti A, de la Peña Mayor P, Martínez Ferri M, Poza Aldea JJ, Gomez Alonso J, Mercadé Cerdá JM. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients. Neurologia. 2015 Oct;30(8):510-7. English, Spanish. doi: 10.1016/j.nrl.2014.08.002. Epub 2015 Jan 21. PMID: 25618222. 可以实施硬膜外麻醉。 Epidural anaesthesia can be administered. Mauri Llerda JA, Suller Marti A, de la Peña Mayor P, Martínez Ferri M, Poza Aldea JJ, Gomez Alonso J, Mercadé Cerdá JM. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients. Neurologia. 2015 Oct;30(8):510-7. English, Spanish. doi: 10.1016/j.nrl.2014.08.002. Epub 2015 Jan 21. PMID: 25618222. 不需禁止使用前列腺素。 Using prostaglandins is not contraindicated. Mauri Llerda JA, Suller Marti A, de la Peña Mayor P, Martínez Ferri M, Poza Aldea JJ, Gomez Alonso J, Mercadé Cerdá JM. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients. Neurologia. 2015 Oct;30(8):510-7. English, Spanish. doi: 10.1016/j.nrl.2014.08.002. Epub 2015 Jan 21. PMID: 25618222. 分娩后2-3周应检查血浆药物浓度。若妊娠期间调整了AEDs剂量，产后应再次调整剂量，尤其是需要哺乳的患者。妊娠期使用PRM、OXC和LTG的患者，应立即监测（In cases of treatment with PRM, OXC, and LTG, monitor immediately）。 Plasma levels should be checked 2 to 3 weeks after childbirth. If doses were changed during pregnancy, they should be adjusted again, especially if patient is breastfeeding. In cases of treatment with PRM, OXC, and LTC, monitor immediately. Mauri Llerda JA, Suller Marti A, de la Peña Mayor P, Martínez Ferri M, Poza Aldea JJ, Gomez Alonso J, Mercadé Cerdá JM. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients. Neurologia. 2015 Oct;30(8):510-7. English, Spanish. doi: 10.1016/j.nrl.2014.08.002. Epub 2015 Jan 21. PMID: 25618222. 提供关于睡眠卫生（sleep hygiene）的建议。 Advice on sleep hygiene. Mauri Llerda JA, Suller Marti A, de la Peña Mayor P, Martínez Ferri M, Poza Aldea JJ, Gomez Alonso J, Mercadé Cerdá JM. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients. Neurologia. 2015 Oct;30(8):510-7. English, Spanish. doi: 10.1016/j.nrl.2014.08.002. Epub 2015 Jan 21. PMID: 25618222.

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