Epilepsy and pregnancy. New issues for an old disorder

Clinicians and their women patients with epilepsy face difficult decisions. There is evidence to suggest that antiepileptic drugs increase the risk of major malformations, minor anomalies, neonatal hemorrhage, and delayed fetal growth and development. Maternal seizures also appear to be disadvantageous to the fetus, increasing the risk of miscarriage, premature labor, intracranial hemorrhage, and perhaps, developmental or learning difficulties. Both medications and seizures have the potential to cause difficulties. This article discusses change in antiepileptic drug metabolism, changes in seizure frequency, adverse pregnancy outcomes, and principles of management.