Ketogenic diet therapy for epilepsy during pregnancy and lactation: An international survey exploring clinician perspectives.
Level 5 - mechanism / opinion, no new human data
Cross-sectional survey of clinician opinions and self-reported practices without direct patient outcome data
PubMed 40439278 · doi:10.1002/epi4.70067
What was done
An international online survey was distributed between December 2023 and June 2024 to healthcare professionals (HCPs) managing ketogenic diet therapy (KDT) in people of childbearing potential with epilepsy or glucose transporter type 1 deficiency syndrome (Glut1DS). The study assessed clinician recommendations, safety concerns, and management strategies regarding KDT use during pregnancy and lactation.
What was found
Thirty-five HCPs reported counseling patients about KDT use in pregnancy. Sixty percent of HCPs advised against KDT during pregnancy, citing insufficient safety data, limited personal expertise, and unknown impacts on fetal development. Among the 40% who recommended KDT in pregnancy, there was no consensus on the specific diet version or macronutrient distribution. Only 5 HCPs had counseled on lactation adaptations; these HCPs most commonly recommended the Low Glycemic Index Treatment or modified Atkins diet, and all 5 unanimously recommended blood ketone monitoring.
Why it matters
This paper identifies substantial clinical uncertainty and hesitation regarding KDT in pregnancy and lactation. It emphasizes the need for international pregnancy registries to systematically gather maternal and fetal safety data.
Limits
The study is limited by a small sample size (n = 35 for pregnancy, n = 5 for lactation) and potential self-selection bias. It measures clinician opinions and self-reported practices rather than direct patient, fetal, or seizure outcomes.
Cited by
- context According to the G1D Foundation, a strict ketogenic diet is considered dangerous for 99% of pregnancies, with doctors recommending a low glycemic index diet instead.