Pregnant women with
epilepsy are at increased risk of
seizures and complications. An increase in seizure frequency is seen in 25-30% of pregnant women with
epilepsy; the offspring of mothers who experienced
seizures during pregnancy are at a 2.5 times higher risk for
seizures later in life. One of the main reasons for the increase in
seizures during pregnancy is a decline in plasma concentrations of
antiepileptic drug (AED) that occurs as pregnancy progresses, largely as a result of marked alterations in
plasma protein binding. It is well known that
epilepsy represents a risk for a variety of adverse pregnancy outcomes or malformations, especially in polytherapy. The adverse outcomes range from dysmorphic features to
hemorrhagic disorders resulting from a deficiency of
vitamin K-dependent
clotting factors or to
spina bifida.
Folic acid supplements appear to reduce the risk of
spina bifida. A strong genetic link seems to exist for many of the malformations that occur, and more research is required in this field. In the meantime, there are interventions that clinicians can already make to reduce the risk of adverse outcomes, such as seizure control without toxicity, monotherapy, and preconceptual use of
vitamins with
folate.