Therapy Insight: Clinical Management of Pregnant Women With Epilepsy

Authors and Disclosures

A.M. Pack is an assistant professor of clinical neurology at Columbia University College of Physicians and Surgeons, New York, NY, USA.

Competing Interests: The author declared she has no competing interests.

Sidebar: Glossary

Tonic-clonic Seizures: Seizures that begins with rigidity (tonic phase), followed by repetitive clonic activity of all extremities

Status Epilepticus: Continuous seizure activity without recovery of consciousness or return to neurological function

Coarctation: A narrowing of the passageway of a blood vessel

Tetralogy Of Fallot: A congenital heart anomaly that consists of pulmonary stenosis, ventricular septal defect, dextroposition of the aorta (aorta is on the right side instead of the left) and hypertrophy of the right ventricle

Suture Synostosis: Union by means of bone; the complete closing up and obliteration of sutures

Hypospadias: Congenital defect in males where the urethral opening is on the underside of the penis or the perineum, rather than on the glans

Polydactyly: The condition of having more than the normal number of digits

Myelomeningocele: A congenital defect, usually occurring in the lumbosacral region of the spine (lower back), in which the neural arches fail to close, thereby exposing the contents of the spinal canal posteriorly

Meningomyelocele: A congenital defect that is characterized by the protrusion of the membranes and cord through a defect in the vertebral column

Patent Foramen Ovale: Incomplete closure of the septum that divides the two atrial chambers of the heart

Patent Ductus Arteriosus: A condition in which the normal channel between the pulmonary artery and the aorta fails to close at birth

Hydronephrosis: Abnormal enlargement of a kidney

Pylorostenosis: Stricture or narrowing of the orifice of the pylorus

Ocular Hypertelorism: Extreme width between the eyes

Alpha-Fetoprotein: Dominant serum protein in early embryonic life; alpha-fetoprotein can be an important marker for the prenatal diagnosis of anencephaly and other open neural tube defects such as spina bifida

Cytochrome P450 Enzyme System: A pathway involving a superfamily of heme proteins that are present in the inner membrane of mitochondria or in the endoplasmic reticulum of liver cells, where they metabolize endogenous and exogenous toxins, drugs, xenobiotics and other potentially harmful molecules

Sidebar: Key Points

• For women with epilepsy, pregnancy raises unique clinical management concerns, as both seizure activity and antiepileptic drug (AED) treatment can have consequences for the developing fetus
  
  

• Seizure frequency can increase or decrease in an unpredictable manner during pregnancy because of multiple factors, including hormonal changes, and alterations in maternal physiology that affect the pharmacokinetics of AEDs
  
  

• Ideally, women should be prescribed the most effective and best-tolerated AED regimen before becoming pregnant, as changing medication once pregnant might not be practical
  
  

• Retrospective and prospective studies indicate that prenatal exposure to AEDs is associated with an increased risk of major and minor malformations, and might also have adverse effects on cognitive development
  
  

• Women treated with AEDs during pregnancy should have their drug levels monitored throughout pregnancy, and have their doses adjusted accordingly
  
  

• Breastfeeding is a viable option for women with epilepsy who are being treated with AEDs, but careful monitoring is required if the mother is using phenobarbital, primidone, ethosuximide or lamotrigine