Management of epilepsy in pregnancy

Pregnancies in women with epilepsy need careful management, by both the medical and obstetric teams, owing to the increased incidence of complications and adverse outcomes of pregnancy. By the time a pregnant woman with epilepsy presents, the major fetal organs are significantly formed, apart from the brain, and the development of which may be impaired by the maternal intake of valproate. Women of child-bearing age need to be counseled and told to seek advice regarding their anticonvulsant antiepileptic drug (AED) therapy, should they wish to become pregnant. All major AEDs are teratogenic, but the main risk to the developing fetus appears to be when the mother is on polytherapy, especially if sodium valproate forms part of the combination. Other issues that need to be discussed include the methods and consequences of prenatal screening, genetics of seizure disorder, folic acid and vitamin K supplements, labor, breast feeding and care and safety of the child.