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
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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.
Plasma levels of antiepileptic medication should be monitored during the third trimester and delivery to ensure that the medication is given in adequate strength to prevent seizures. In addition, the patient should be counseled about the importance of taking her medication consistently during this period.5
If the patient experiences a seizure during labor and delivery, treat her promptly with an intravenous benzodiazepine, preferably lorazepam.8 However, be aware that phenobarbital, primidone, and benzodiazepines remain in neonatal plasma for several days after delivery and may cause sedation or neonatal withdrawal syndrome.9
Do not give magnesium sulfate for epileptic seizures unless the seizures first appear during the third trimester or immediate postpartum period and could be associated with eclampsia. In such cases, treat the eclampsia and evaluate the patient for other potential causes of the seizures.5
