Management of epilepsy and pregnancy: an obstetrical perspective

Women with epilepsy who take antiseizure medicines have successful and unremarkable pregnancies the majority of the time. Achieving seizure freedom is important for successful pregnancies, and it is also highly predictive of seizure freedom during pregnancy. From data derived from the general population, vitamin supplementation is important to prevent birth defects, and women with epilepsy of child-bearing potential should be encouraged to take folic acid supplements daily. Pregnant women with epilepsy should have their pregnancies screened for neural tube defects with a maternal serum alpha-feto-protein level at 15-16 weeks of gestational age and an anatomical survey by ultrasound at 18-22 weeks of gestation. Pregnant women with epilepsy do face a higher risk of both non-proteinuric hypertension and induction of labor than do then general population, as well as an approximately twofold risk of cesarean section. However, the indication for cesarean section is unclear and appears not to be related to fetal distress and may in part be influenced by caution at the time of delivery for such patients. Collaboration between the patient, neurologist, and obstetrician is important for managing this dynamic and complex clinical situation.