|September 2009 · Vol. 21, No. 09
Guidelines confirm safety of pregnancy in women who have epilepsy—with caveats
Otherwise healthy women can expect an uneventful pregnancy and delivery, provided they avoid valproate, seizures, and smoking
Levels of antiepileptic drugs tend to drop during pregnancy, so a dosage adjustment may be necessary to prevent seizures
For more on the AAN/AES guidelines on epilepsy and pregnancy, visit the AAN Web site at http://www.aan.com/go/practice/guidelines
Tonic-clonic seizures occur during labor in 1% to 2% of women who have epilepsy, and in an additional 1% to 2% of women in the 24 hours immediately following delivery
First-trimester exposure to the antiepileptic drug valproate increases the risk of major congenital malformation, particularly neural tube defects and facial clefts, according to recent guidelines developed by the American Academy of Neurology (AAN) and the American Epilepsy Society (AES).1-3 The guidelines recommend that women who have epilepsy avoid taking valproate during pregnancy.
“Good evidence shows that valproate is linked to an increased risk for fetal malformations and decreased thinking skills in children, whether used by itself or with other medications,” said lead guideline author Cynthia Harden, MD, director of the Epilepsy Division at the University of Miami’s Miller School of Medicine and member of the AAN.