Therapy Insight: Clinical Management of Pregnant Women With Epilepsy

Alison M. Pack


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

In This Article


Careful management of pregnant women with epilepsy who are being treated with AEDs is important, as seizure frequency can change during pregnancy, and both seizure activity and AED drug treatment might have consequences for the developing fetus, including increased rates of stillbirth, teratogenesis and cognitive delay. Some AEDs probably have more adverse effects than others. In addition, drug-level monitoring and dosage adjustment throughout pregnancy is warranted. Vitamin K1 at a dose of 10 mg/day should be given in the last month of pregnancy, particularly in women who are taking cytochrome P450 enzyme-inducing AEDs. Breastfeeding is generally recommended, although there is differential transfer of individual AEDs in breast milk, and the infant should be observed clinically. For all women with epilepsy of reproductive age, preconceptual counseling is important. Such counseling should include optimization of the AED regimen, and advising the women to take supplemental folic acid.

Issues that need to be addressed in further studies include better differentiation of which AEDs result in higher rates of major malformations, defining cognitive effects of in utero AED exposure, and establishing better guidelines for breastfeeding. The pregnancy registries discussed are likely to better define potential teratogenicity of individual AEDs, especially of the newer AEDs where information is lacking. The NEAD study will define prospectively the potential cognitive effects of the studied AEDs (phenytoin, carbamazepine, valproate and lamotrigine). Further studies are needed, however, to address cognitive effects of other AEDs; particularly if these agents are used in increasing numbers during pregnancy.

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