title: [Epilepsy and Pregnancy].
abstract: BACKGROUND
  On average, female patients with epilepsy have 0.9 children, which is below the birth rate of healthy women. One reason is insufficient counselling.
  
  
  OBJECTIVE
  To summarize the current data relevant to counselling pregnant women with epilepsy.
  
  
  METHODS
  Discussion of research and recommendations concerning seizure control during pregnancy, pregnancy and birth complications, congenital malformations, and breastfeeding.
  
  
  RESULTS
  Changes in seizure frequency during pregnancy are variable and partly due to changes in the serum concentrations of antiepileptic drugs. Epilepsy patients have a slightly higher risk for some pregnancy and birth complications including spontaneous abortion, pre- and postpartum bleeding, induction of labour, and caesarean section. In particular, the administration of valproic acid can lead to congenital malformations and a lower IQ of the child. Folic acid seems to have a protective effect. Data concerning breastfeeding are insufficient.
  
  
  CONCLUSIONS
  If possible, epilepsy patients should be treated with a low-dose monotherapy during pregnancy and valproic acid should be avoided. Treatment with lamotrigine requires frequent control of serum concentration. Supplementary folic acid (5 mg daily dose) is recommended. Epilepsy is not an indication for a caesarean section.
authors.affiliation: Epilepsiezentrum Hessen am Universitätsklinikum Gießen und Marburg, Standort Marburg, Klinik für Neurologie, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland. hattemer@med.uni-marburg.de.
authors.forename: K
authors.initials: K
authors.lastname: Menzler
authors.affiliation: Epilepsiezentrum Hessen am Universitätsklinikum Gießen und Marburg, Standort Marburg, Klinik für Neurologie, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Fuest
authors.affiliation: Epilepsiezentrum Hessen am Universitätsklinikum Gießen und Marburg, Standort Marburg, Klinik für Neurologie, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
authors.forename: I
authors.initials: I
authors.lastname: Immisch
authors.affiliation: Epilepsiezentrum Hessen am Universitätsklinikum Gießen und Marburg, Standort Marburg, Klinik für Neurologie, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Knake
mesh_terms: D000013:Congenital Abnormalities / Q000175:diagnosis / Q000517:prevention & control*; D037001:Directive Counseling / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis* / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000175:diagnosis / Q000517:prevention & control*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy*
keywords: Anticonvulsants; Breastfeeding; Folic acid; Seizures; Valproic acid