Epileptic disorders in pregnancy: An overview

Cynthia L. Harden, Nitin K. Sethi

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations

Abstract

Purpose of review: Much new information has now become available regarding outcomes of women with epilepsy (WWE) and pregnancy. Recent findings: Valproate is associated with a risk of major congenital malformations within a range of 6.2-10.7%, though antiepileptic drugs (AEDs) other than valproate when used as monotherapy are associated with major congenital malformation rates ranging from 2.9 to 3.6%; the rate of major congenital malformations in WWE not treated with AEDs was similar to this at 3.1%. Seizure freedom in 9-12 months before pregnancy is associated with seizure freedom during pregnancy. A decline in AED levels can be expected during pregnancy, most dramatically for lamotrigine (but with marked variability between patients) and least with carbamazepine. Neonates born to WWE taking AEDs who receive vitamin K 1 mg intramuscularly at birth are not at additional risk of hemorrhagic disease of the newborn. Summary: The use of valproate and polytherapy with any AED combinations should be avoided, if clinically appropriate, during pregnancy. Seizure freedom in 9-12 months before pregnancy should be a goal. AED levels should be maintained at or near the therapeutic level known for that individual patient, with frequent monitoring during pregnancy as appropriate for the patient and the AED.

Original languageEnglish
Pages (from-to)557-562
Number of pages6
JournalCurrent Opinion in Obstetrics and Gynecology
Volume20
Issue number6
DOIs
StatePublished - Dec 2008
Externally publishedYes

Keywords

  • Antiepileptic drugs
  • Epilepsy
  • Major congenital malformations
  • Pregnancy

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