Therapy Insight: Clinical Management of Pregnant Women With Epilepsy

Alison M. Pack


Nat Clin Pract Neurol. 2006;2(4):190-200. 

In This Article

Preconceptual Counseling

Women with epilepsy need to plan their pregnancies carefully, as changes in AED regimens might be beneficial. Ideally, women should be prescribed the most effective and best-tolerated AED regimen at the lowest possible dose before becoming pregnant. Changing medication once pregnant is not always practical—lamotrigine therapy, for example, cannot be initiated quickly—and might subject the mother and developing fetus to additional risks as a secondary consequence of seizures. If possible, women on polytherapy should be switched to monotherapy, as data indicate that polytherapy is associated with a higher risk of teratogenic abnormalities. If a woman has not had a seizure in 2 years or more, tapering off medication can be an option.

Because folic acid fortification in cereal grains has significantly decreased the rates of neural tube defects in the US and Canada, the American Academy of Neurology recommends that all women of childbearing age take folic acid supplementation at a dose of 0.8-4.0 mg/day. No definitive proof exists, however, that folic acid has protective effects in children whose mothers take AEDs.[2] Possible explanations for the lack of effect include an inability to overcome AED-related teratogenic mechanisms, or inadequate doses.


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