Pregnancy is a time of physical, physiological and psychological challenge. For women with epilepsy, as well as its potential for joy and fulfilment, pregnancy may bring additional risks and difficulties. Clinicians must anticipate and prevent these complications, ensuring that pregnancy, delivery and motherhood proceed without obstetric or medical complications, using available evidence to balance individual risks of undertreatment and overtreatment. Here we review epilepsy management in pregnancy, identifying some of the known effects of epilepsy and its treatment on gestation, fetal malformation, delivery, and neurocognitive and behavioural development. We outline strategies to reduce obstetric and fetal complications in women with epilepsy, while recognising the sometimes competing need to maintain or improve seizure control. We reinforce the importance of identifying those at highest risk, who may require additional measures or safeguards.
- sudden death
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Contributors The article was commissioned by the editors. JPL and JJC drew up the first draft, which was amended by SS.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests JJC has received speaker fees and honoraria from GlaxoSmithKline, UCB Pharma, Pfizer, Janssen-Cilag, Eisai and Desitin. SS has received speaker fees from Arvelle and Neurology Masterclass. Over the last 3 years, JPL has received speaker fees and honoraria from UCB Pharma, Janssen-Cilag, Eisai and Arvelle.
Provenance and peer review Commissioned. Externally peer reviewed by Lucy Kinton, Southampton, UK, and Lina Nashef, London, UK.