Maternal and fetal implications of anticonvulsive therapy during pregnancy.
A team approach with close communication among the obstetrician, neurologist, pediatrician, and patient will result in an uneventful pregnancy in most epileptic women. Women should be counseled regarding the greater than 90% likelihood of a favorable outcome. Maternal and neonatal outcome can be optimized by carefully evaluating the clinical necessity of anticonvulsant medications preconceptionally. One can then prescribe an appropriate choice based on seizure type and history of response, with a goal of achieving monotherapy at the lowest effective dose. Nonpharmacologic intervention, such as avoiding high levels of stress and sleep deprivation, will also help the patient to remain seizure-free during the pregnancy. In addition, folic acid and vitamin K can help optimize neonatal outcome. In short, most epileptic women will experience a normal pregnancy, labor, and delivery of a healthy baby and can breastfeed if desired. Although the incidence of congenital malformations with any anticonvulsant is increased, the actual incidence remains relatively low. Despite the shortcomings and risks of anticonvulsants, adequate therapy is clearly preferable to uncontrolled seizure activity. Women should be encouraged to optimize their anticonvulsive therapy prior to pregnancy, usually resulting in adequate therapy throughout the pregnancy and postpartum, with a happy and healthy outcome for mother and infant.