Epileptic disorders in pregnancy: an overview.
OBJECTIVE
Much new information has now become available regarding outcomes of women with epilepsy (WWE) and pregnancy.


RESULTS
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.


CONCLUSIONS
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.
Harden
Cynthia L
CL
Department ofNeurology, University of Miami Miller School of Medicine, Miami, Florida, USA. charden@med.miami.edu
Sethi
Nitin K
NK
D000014:Abnormalities, Drug-Induced / Q000209:etiology / Q000517:prevention & control; D000927:Anticonvulsants / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D004827:Epilepsy / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005492:Folic Acid / Q000378:metabolism; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D000077213:Lamotrigine; D009774:Obstetrics / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D012306:Risk; D012640:Seizures / Q000150:complications; D014227:Triazines / Q000627:therapeutic use; D014635:Valproic Acid / Q000494:pharmacology
D000927:Anticonvulsants; D014227:Triazines; D002220:Carbamazepine; D014635:Valproic Acid; D005492:Folic Acid; D000077213:Lamotrigine