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Epilepsy & Pregnancy
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Epilepsy is the most common neurological disorder in pregnant women
Most pregnancies are routine, and most of the children delivered are healthy
However, both seizures and antiepileptic drugs can adversely affect the foetus
Women should undergo evaluation by their neurologist regularly during pregnancy.
Serum AED levels should be monitored closely and adjusted if seizures occur.
Both free and total levels of PHT & CBZ should be checked.
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AED levels in pregnancy
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Drug levels decline during pregnancy owing to changes in liver metabolism, renal clearance, volume of distribution, and absorption.
Free levels decline less than total levels because of changes in protein binding.
The period of maximal decline is the first trimester for phenytoin and phenobarbital, & the third trimester for carbamazepine ; valproic acid levels decline throughout pregnancy .
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Investigations during pregnancy AED levels
6-10 wks AED levels (free and total), serum folate level
15-16 wks Maternal serum AFP, amniocentesis, AED levels
28 wks AED levels
34-36 wks AED levels, maternal vitamin K
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Investigations during pregnancy Ultrasound
Management during pregnancy
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Supplemental folic acid should be continued during pregnancy
If a neural tube defect is identified, for those who continue their pregnancy, a cesarean
section should be planned before the onset of labor to avoid trauma to the spine
during delivery and potentially to improve functional outcome
Women need to obtain adequate sleep because sleep deprivation might increase seizure frequency.
Vitamin K, 20 mg a day orally, should be administered for the 2 weeks before delivery to decrease the risk of maternal and neonatal bleeding .
Delivery should take place in a clinic with facilities for providing specialized care to epileptic patients and with an associated neonatal intensive care unit.
AED administration should be continued during labor.
Parenteral medication or additional oral doses may be necessary because of decreased absorption during a prolonged labor.
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Risks to the Baby
Since the enzyme-inducing antiepileptic drugs are competitive inhibitors of prothrombin precursors, exposed infants are at increased risk for hemorrhage into body cavities and brain .
The risk is greatest on the first day of life
Infants may need prolonged coagulation studies
Administration of vitamin K reduces the risk of hemorrhage.
Current guidelines recommend the oral administration of 2 mg of vitamin K at birth, at the end of the first week, and in the fourth week of life
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