Women's health: Edited by Gubby Ayida and Joseph AquilinaEpileptic disorders in pregnancy: an overviewHarden, Cynthia La; Sethi, Nitin KbAuthor Information aUniversity of Miami Miller School of Medicine, Miami, Florida, USA bWeill Cornell Medical College, New York, New York, USA Correspondence to Cynthia L. Harden, MD, Professor of Neurology, Epilepsy Center-Department of Neurology, University of Miami, Leonard M. Miller School of Medicine, 1120 NW 14th Street, Suite 1324, Miami, Florida, USA Tel: +1 305 243 4744; e-mail: email@example.com Current Opinion in Obstetrics and Gynecology: December 2008 - Volume 20 - Issue 6 - p 557-562 doi: 10.1097/GCO.0b013e3283184059 Buy SDC Metrics 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. © 2008 Lippincott Williams & Wilkins, Inc.