Feature Article

Pregnancy and epilepsy – balancing the risks

Feature Article

Pregnancy and epilepsy – balancing the risks

Cecilie M Lander

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Abstract

Excellent pregnancy outcomes for mother and child occur in more than 90% of the women with epilepsy who choose to become pregnant, but there are some specific health risks to both mother and child that need to be appreciated and controlled as much as possible.

Key Points

  • Information given in the early years of epilepsy management is very helpful preparation for the time when a pregnancy is desired.
  • While there is no evidence that simple partial seizures, complex partial seizures or absence seizures result in any increased risk to the fetus, generalised tonic–clonic seizures are potentially harmful to both mother and child. The maternal risk of recurrent generalised seizures (in particular, status epilepticus) is often understated and overlooked in the anxiety to avoid the use of antiepileptic drugs.
  • Approximately 15 to 30% of women with epilepsy will have an increase in the number of seizures in pregnancy.
  • In pregnancy, the metabolism of some antiepileptic drugs is altered and their bioavailability is reduced. Monitoring is necessary.
  • In pregnant women with epilepsy, there may be an increased risk of haemorrhagic disease of the newborn, especially if the mother is taking enzyme-inducing antiepileptic drugs. Therefore, vitamin K supplements are recommended for all neonates.
  • The single most appropriate antiepileptic drug for the maternal epilepsy should be continued in pregnancy. It seems logical to give more frequent, smaller doses or a slow release preparation to keep the peak drug concentration down.
  • The benefits of breastfeeding are generally thought to outweigh the risks of drug to the baby.