Epilepsy Complicating Pregnancy

Purpose of Review Epilepsy is the fourth most common neurological disorder, affecting 30 million females with epilepsy worldwide, but is the most common to require continued treatment during pregnancy with possible teratogenic medications, to counter harmful consequences of uncontrolled seizures for both mothers and their children. Despite the misbelief that epilepsy affects reproductive health and leads to mostly poor pregnancy outcomes, recent studies reveal that fertility and maternal and fetal pregnancy outcomes for the majority of people with epilepsy are similar to those in the general population. This review will summarize recent research on the risk factors to be considered by patients and providers and recommend practices to mitigate these risks. Recent Findings A large prospective study demonstrated that people with epilepsy seeking pregnancy, without prior known disorders that lower fertility, have similar likelihood of achieving pregnancy, time to pregnancy, and live birth rates compared with their peers without epilepsy. Providers' practice has changed to favor prescribing certain antiseizure medications with demonstrated low teratogenicity, to monitor people with epilepsy more methodically during pregnancy, delivery and early postpartum with personalized recommendations that have significantly improved fetal and maternal outcomes over the past decades. The most commonly used antiseizure medications undergo significant pregnancy-related clearance changes, and therapeutic drug monitoring emerged as best standard of care to prevent seizure worsening and related negative health outcomes for mothers and their unborn children. Overall, people with epilepsy have higher rates of C-section, hemorrhage, and mortality, when compared to those without epilepsy, though occurring in only a small minority. Risks of anxiety and mood problems are increased for pregnant people with epilepsy. Breastfeeding should be encouraged in people with epilepsy who are taking antiseizure medications, as exposure to medications is lower than in utero and possible negative effects are offset by neurodevelopmental benefits of breastfeeding. Summary Pregnancies for people with epilepsy may carry higher risks for both mothers and children and require careful planning and monitoring with the help of a multidisciplinary team. With adequate preconception planning and monitoring during pregnancy/postpartum, people with epilepsy can expect favorable pregnancy outcomes for themselves and their children.