Management guidelines for pregnant women living with epilepsy: An integrative literature review

Abstract

Background: Epilepsy affects more than 50 million people worldwide, with a significant number of safety-related concerns arising in pregnant women. Precise management needs to include a vast array of stepwise protocols; however, no studies have been conducted to compare current South African guidelines to international norms. Aim: The aim of this integrative literature review was to identify discrepancies, if any, in the current protocols for treating pregnant women with epilepsy within the public sector of South Africa when measured against global standards. Method: An integrative literature review was conducted using the Whittemore and Knafl method. The following databases and search engines were used: PubMed, EBSCOhost, Science Direct, Medscape, African Journals Online, Cochrane Library, Google scholar, Google and MedlinePlus. The study included qualitative literature from all levels of evidence from 2006 to 2023. The data were evaluated using the PRISMA flow chart and analysed using the Cooper method. On completion of critical appraisal, 22 articles met the inclusion criteria and were analysed thematically. Results: The review identified several areas that can be enhanced to improve patient management and outcomes such as therapeutic drug monitoring and targeted dosing, folic acid supplementation, the use of antepartum vitamin K, high-resolution ultrasounds, elimination of sodium valproate in women of childbearing potential, monotherapy and endorsing frequent obstetrician visits. Conclusion: The study validated many differences between guidelines used in South Africa and internationally. Some of the prominent findings included areas focused on patient medication, screening, physician visits and pharmacovigilance. Contribution: The findings can be used to enhance and provide evidence-based recommendations in the areas that are not well developed within the current guidelines.

Keywords

• epilepsy
• pregnancy
• anti-epileptic drugs
• major congenital malformations
• therapeutic drug monitoring