Anticonvulsant Drugs and Pregnancy

The majority of babies born to mothers with epilepsy are normal. Nevertheless, women with epilepsy, especially those receiving anti-epileptic drugs, have an increased risk of giving birth to a baby with major malformations , minor anomalies or dysmorphic features compared to women without epilepsy. It is possible that some of this risk is caused by a genetic predisposition for birth defects inherent in some families.
Pre-natal screening can detect many major malformations and anomalies.

Anticonvulsant treatment during pregnancy should be chosen so as to minimise the occurrence of convulsions. Anticonvulsant therapy is associated with an increased risk of neural tube defects. Periconceptual folic acid supplementation is therefore of particular importance for women with epilepsy.

Before and during pregnancy, the aim should be the lowest dose of anticonvulsants that protects against seizures. Pre-pregnancy withdrawal of anticonvulsants could be considered for selected women and a change from poly to monotherapy could be considered for some others.

Vitamin K . All women with epilepsy should be advised to take increase daily folic acid intake while attempting to conceive and for at least 12 weeks after conception.
The babies of women treated with enzyme-inducing anticonvulsants (carbamazepine, phenytoin, primidone, phenobarbitone) are at increased risk of haemorrhagic disease of the newborn caused by deficiency of vitamin K-dependent clotting factors. Women on these drugs should be treated prophylactically with vitamin K daily from 36 weeks gestation until delivery and their babies should receive Vitamin K at birth.

Breastfeeding . Epilepsy itself and anticonvulsants are not contra-indications to breast feeding. All women, including those with epilepsy, who wish to breast feed should be offered encouragement and support to do so.

Parents should be reassured that, although children born to parents with epilepsy have an increased risk of developing epilepsy themselves , this risk is around 3% for most forms of epilepsy, (but significantly higher for women with a familial tendency to epilepsy or with certain specific syndromes).

The information in this page is presented in summarised form and has been taken from the following source(s):
1. The Management of Pregnancy In Women with Epilepsy, A Clinical Practice Guideline for Professionals Involved in Maternity Care, Scottish Obstetric Guidelines and Audit Project: http://www.show.scot.nhs.uk/