Pregnancies in women with epilepsy

The aim of this study was to analyse the outcomes of all the pregnancies of each woman with epilepsy in the Australia Pregnancy Register. Data from 1,290 pregnancies in 612 women with epilepsy were analysed, including 156 women who took no AEDs in the first trimester of at least one pregnancy. Spontaneous miscarriages were more frequent in AED-exposed pregnancies. There was an overall 13 center dot 95% risk of a woman taking AEDs during pregnancy having a malformed foetus at some stage of her reproductive career, at least to the time of the present analysis. This risk increased with (i) first trimester exposure to VPA, particularly in maternal doses above 1,100-1,400 mg per day, (ii) the number of pregnancies a woman underwent, although the individual pregnancy risk did not increase from one pregnancy to the next, (iii) history of a previous foetus with a malformation from an AED-associated pregnancy, (iv) twin pregnancies, and (v) family histories of foetal malformations. These findings provide a basis for advising women with epilepsy about the likely overall outcomes of their child-bearing careers, and suggest that both genetic and drug-related factors operate in producing foetal malformations. The issue is one of frequent concern and discussion with participants in the Pregnancy Register.