title: Management of women with epilepsy: from preconception to post-partum.
abstract: OBJECTIVE
  The physiological changes during pregnancy can significantly alter antiepileptic drug (AED)'s absorption, distribution, metabolism and elimination, thus influencing their plasma concentration. Considering that the risks of using old and new AEDs during pregnancy are still debated, our aim is to review the available evidence on this topic.
  
  
  METHODS
  Narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases.
  
  
  RESULTS
  The old AEDs generation (benzodiazepines, phenytoin, carbamazepine, phenobarbital and valproic acid) is teratogenic: minor congenital malformations, such as facial dysmorphism and other anomalies, occur in 6-20% of infants exposed to AEDs in utero; this value is two times greater than the value reported in the general population. Major congenital malformations (MCM) such as cleft lip and cleft palate, heart defects (atrial septal defect, Fallot's tetralogy, ventricular septal defect, aortic coarctation, patent ductus arteriosus, and pulmonary stenosis) and urogenital anomalies were estimated to be 4-6% of infants born from mothers treated with AEDs, compared to 2-3% of the general population.
  
  
  CONCLUSIONS
  It is essential to inform women treated with AED that planning pregnancy is necessary, when possible. The problems related to antiepileptic therapy and the possibilities of prenatal diagnosis should be accurately discussed with the patient, when possible before pregnancy: individual circumstances, desire to have children, severity of epilepsy, risks of seizures, family history of congenital malformations and all other potential risk factors must be considered, involving the patient in shared clinical decision-making.
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via C. Valeria 1, 98125, Messina, Italy. antlagana@unime.it.
authors.forename: Antonio Simone
authors.initials: AS
authors.lastname: Laganà
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
authors.forename: Onofrio
authors.initials: O
authors.lastname: Triolo
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: D'Amico
authors.affiliation: Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
authors.forename: Sandy Maria
authors.initials: SM
authors.lastname: Cartella
authors.affiliation: Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Sofo
authors.affiliation: Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
authors.forename: Francesca Maria
authors.initials: FM
authors.lastname: Salmeri
authors.affiliation: Department of Reproduction, University Medical Center Ljubljana, Slajmerjeva 3, 1000, Ljubljana, Slovenia.
authors.forename: Eda
authors.initials: E
authors.lastname: Vrtačnik Bokal
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Spina
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D019468:Disease Management; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D036801:Parturition; D049590:Postpartum Period; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012307:Risk Factors; D012640:Seizures / Q000150:complications / Q000188:drug therapy*; D013723:Teratogens
chemical_list: D000927:Anticonvulsants; D013723:Teratogens
keywords: Antiepileptic drugs; Epilepsy; Pharmacokinetics; Pregnancy; Prevention