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Counsel on Increased Risk with Pregnancy
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Over 90 percent of women with epilepsy have good pregnancy outcomes.
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Healthy women have a 2-3% chance of having a baby with a major birth defect. Women
with epilepsy have a 4-6% chance. Reasons for this increase are not fully
understood.
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Seizures during pregnancy have significant risk for mother and fetus. Most
anti-seizure medications are known or potential teratogens but the maternal and
fetal risks of seizures usually outweigh the risks associated with medication
treatment.
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Postpartum sleep deprivation may lower seizure threshold.
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Management
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Optimize seizure control prior to pregnancy. For medications that require serum
level monitoring, serum levels may change during pregnancy and should be monitored
regularly.
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Sudden discontinuation of an anti-seizure medication can precipitate seizures.
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Anti-seizure medication changes should be made in consultation with a health care
professional experienced in managing epilepsy.
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Many providers will consider withdrawal of anti-seizure medications after 2 years
without seizures. If seizure free during the 9 months prior to conception, patient
is likely to remain seizure free during pregnancy.
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All women with epilepsy should take at least 0.4mg of folic acid daily. Women on
anti-seizure medication that increases the risk for neural tube defects should take
4.0 mg folic acid daily.
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When possible, minimize medication related reproductive risk by managing seizure
activity with monotherapy or the fewest number of medications possible.
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