Epilepsy and pregnancy. A comparative study two decades afterwards

Background: Epilepsy is the most frequent neurologic disease during pregnancy. First generation antiepileptic drugs involve a direct teratogenic effect and imply an increased probability of mother-child complications. During the last three decades, epidemiological modifications in epilepsy presentation have conditioned changes in the pharmacological treatments preferred. These changes impacts perinatal outcomes in pregnant women with this condition, however there are no comparative studies of this nature. Objectives: To compare antiepileptic drug (AED) preferences and perinatal outcome during the last decades in the Mexican population. Methods: Pregnant epileptic women (n=275) and their children, received clinical assessment and follow-up from medical specialists (obstetrician, neurologist, geneticist), and compared with a study of 100 pregnant epileptic women and their children studied in 1996. All patients were studied at the National Institute of Perinatology (INPer), in Mexico City. Results: The administration of monotherapy increased from 61 to 73%, and the frequency of valproate use raised (8-45%). Malformations were more frequent in the current study, increasing minor dysmorphias from 8 to 15% and mayor dysmorphias from 0 to 4%. Conclusions: Mexican women's tendency to use valproate should be explored as possible variables involved in perinatal outcome. Alternative treatments with lower teratogenic rates should be considered for fertile women.