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Feature Article

Pregnancy in women with epilepsy

Srinivasa Raju Yerra, Christine Kilpatrick

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Abstract

Most women with epilepsy will have good obstetric and neonatal outcomes. Nevertheless, all women with the condition should be counselled about the increased risk of obstetric complications, worsening seizure control during pregnancy and adverse neonatal outcomes.

Key Points

  • Women with epilepsy who are taking hepatic enzyme-inducing antiepileptic drugs are at risk of hormonal contraception failure. Changing to an antiepileptic drug that does not induce hepatic enzymes should be considered.
  • Although more than 90% of women with epilepsy have uneventful pregnancies, they should all be counselled about the potential increased risks of obstetric complications, worsening seizure control and adverse neonatal outcomes.
  • The management strategy is to effectively control maternal seizures with the least possible risk to the fetus.
  • Management includes preconception counselling, where appropriate stopping antiepileptic drugs or changing to monotherapy, monitoring of antiepileptic drug levels and folic acid supplementation.
  • An increased risk of birth defects is associated with drug treatment of the epilepsy, rather than the epilepsy itself.
  • Breastfeeding while taking antiepileptic drugs is generally considered safe, the benefits outweighing the perceived risks.

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