Treatment of epilepsy during pregnancy presents a
particular problem, as 1% of pregnant women have a
seizure disorder and all anticonvulsants are potentially
teratogenic. There is a two to three-fold increase in the
incidence of congenital abnormalities in infants of mothers
treated with anticonvulsants during pregnancy. Recognisable
syndromes, often associated with learning disability, occur in a
proportion of pregnancies exposed to phenytoin and sodium
valproate. An increased risk of neural tube defect has been
documented with sodium valproate and carbamazepine
therapy, and periconceptional supplementation with folic acid
is advised. Anticonvulsant therapy during pregnancy may be
essential to prevent the risks of grand mal seizures or status
epilepticus. Whenever possible monotherapy using the lowest
effective therapeutic dose should be employed.
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