[The epileptic mother and her child (author's transl)]

Antiepileptic drugs are thought to be responsible for an abnormally high incidence of post-partum haemorrhages. Data on perinatal mortality of epileptic patients are discordant. Children of epileptic mothers are frequently undersized. Although they have an incidence of malformations 1.25 times higher than average, these may be associated with the severity of seizures and with the disease itself, since there is no evidence that anticonvulsants are teratogenic. The influence of pregnancy on epileptic attacks is extremely variable. Seizures occurring during a pregnancy need not necessarily occur during subsequent pregnancies. There seems to be a positive correlation between eclampsy, late epilepsy, familial epilepsy and abnormal EEGs. Status epilepticus is unusual in child-bearing women. The dosage of several antiepileptic drugs needs to be increased during pregnancy, probably because of accelerated metabolism and reduced intestinal absorption. Decrease in plasma protein levels seems to be of little significance. Antiepileptic drugs which cross the placenta are usually excreted by the newborn within a week, but children of mothers who are given diazepam during delivery may be intoxicated. Drug concentrations in milk are low, but the child must be supervised if the mother takes phenobarbitone or diazepam. However, in most cases breast-feeding is safe. Pregnant epileptic women should be carefully examined throughout pregnancy and post-partum for obstetrical reasons and because the drugs they absorb may give abnormal blood levels.