Pregnancy and birth in women with epilepsy

The literature pertinent to obstetric aspects of the pregnancies in women with epilepsy is reviewed. The small risk (1%) of malformations of fetal central nervous system attributed to the use of carbamazepine or valproate during pregnancy should not discourage women who take these drugs from having children since these malformations can be reliably diagnosed (as well as excluded) during the 15th to 19th weeks of pregnancy with alpha-fetoprotein determinations and high-resolution ultrasound scans. Except for the 1.2- to 3-fold increase in perinatal mortality, the course of pregnancy and labor in women with epilepsy is usually uneventful. Most can have a normal vaginal delivery. Cesarean section is warranted only in a select minority of the difficult cases. Counseling, follow-up, and treatment of pregnant women with epilepsy should be provided at centers with the experience and resources to attend to the very specific problems that sometimes develop.