Most women with
epilepsy will need to continue
antiepileptic drugs prior to and during pregnancy. Pre-conception counseling should be available to all wormen with
epilepsy who are considering pregnancy, and should address obstetrical complications, change in seizure frequency, and adverse pregnancy outcome. Supplementation with
folic acid. 0.4-5 mg/day, is recommended for all women with
epilepsy of childbearing potential, especially 3 months prior to conception and throughout the first trimester. It is advisable to obtain serum drug concentrations before pregnancy, when seizure control is optimal, in order to establish a baseline. Serum concentration should be performed each trimester among patients with good seizure control, and monthly in patients with complicated
epilepsy, breakthrough
seizures, significant side effects, and those treated with
lamotrigine or
oxcarbazepine. The incidence of major congenital malformations in offspring of women treated with
antiepileptic drugs has ranged from 4 to 10%, corresponding to a two-fold increase from the expected incidence in the general population. Malformation rates are higher with
valproate, lower with
carbamazepine and
lamotrigine, and dose-effect relationship has been shown for teratogenicity especially with
valproate. An expert morphological assessment, targeted at the neural axis, heart and face, should be performed at 11-13 weeks and 18-22 weeks. There is generally no
contraindication to breast feeding among mothers with
epilepsy, but further studies are needed to establish the safety of newer
antiepileptic drugs.