Risks and management of pregnancy in women with epilepsy
Mark S. Yerby, MD, MPH
North Pacific Epilepsy Research and Oregon Health and Science University, Portland, OR
Peter Kaplan, MB, FRCP
Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, MD
Teresa Tran, MD
MINCEP Epilepsy Care, Minneapolis, MN
Correspondence: Mark S. Yerby, MD, MPH, North Pacific Epilepsy Research, 2455 NW Marshall Street, Suite 14, Portland, OR 97210; e-mail: Yerby@seizures.net
Dr. Yerby is an unpaid consultant for GlaxoSmithKline and is on the speakers' bureau for Elan, GlaxoSmithKline, Abbott, and Xcel Pharmaceuticals.
Dr. Kaplan receives grants/research support from GlaxoSmithKline, Pfizer/Parke-Davis, UCB Pharma, and Marion Merrill Dow; is a consultant for Abbott, GlaxoSmithKline, Pfizer/Parke-Davis, Novartis, UCB Pharma, Elan, and Ortho-McNeil; and is on the speakers' bureau for Abbott, GlaxoSmithKline, Pfizer/Parke-Davis, Novartis, and UCB Pharma. Dr. Kaplan notes that he is not a major stock shareholder in any of the above companies.
Dr. Tran has indicated she has nothing to disclose.
Most women with epilepsy today can conceive and bear normal, healthy children, but their pregnancies present an increased risk for complications. Pregnancy can exacerbate seizure frequency in some women with epilepsy, and both maternal epilepsy and in utero exposure to antiepileptic drugs can increase the risk of adverse outcomes in children born to women with epilepsy. These outcomes include fetal loss and perinatal death, congenital malformations and anomalies, neonatal hemorrhage, low birth weight, developmental delay, and childhood epilepsy. After reviewing these risks, this article concludes with practical recommendations for reducing these risks and optimizing the management of pregnant women with epilepsy.