This review encompasses issues regarding the management of women with epilepsy and pregnancy, including preconception planning, antiepileptic drug (AED) effects on the exposed offspring, and consequences of seizures during pregnancy, with an emphasis on counseling points and risk management.
In utero valproate exposure continues to show the highest risk of congenital malformations and of adverse cognitive outcomes, including autism, compared to other AEDs. In utero topiramate exposure is associated with facial clefts. In utero exposure to lamotrigine, carbamazepine, phenytoin, and levetiracetam has been evaluated in large numbers of offspring, and all of these AEDs have a low risk of major congenital malformations, near 2.5%. The risk of major congenital malformations due to in utero AED exposure is dose associated. Folic acid taken at the time of conception decreases the risk of adverse cognitive outcomes. AED polytherapy may adversely affect fertility, and in utero exposure of AED polytherapy is associated with infants who are small for their gestational age. Seizure freedom before pregnancy is a good predictor of remaining seizure free during pregnancy.
Counseling points are complex for managing women with epilepsy contemplating pregnancy, including evaluation of AED choice and dose. The physician must have knowledge of the issues to enable an honest discussion and appropriate decision making in partnership with the patient.
Address correspondence to Dr Cynthia L. Harden, North Shore-Long Island Jewish Health System, 611 Northern Boulevard, Suite 150, Great Neck, NY 11021, firstname.lastname@example.org.
Relationship Disclosure: Dr Harden has received personal compensation for activities with GlaxoSmithKline; Lundbeck; UCB SA; and Upsher-Smith Laboratories, Inc. Dr Harden has served in an editorial capacity for UpToDate and received research support from the Epilepsy Therapy Project.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Harden reports no disclosure.