Maternal epilepsy and adverse pregnancy outcomes

Epilepsy is a common neurological disorder affecting 0.3-0.7% of pregnant women. Women with epilepsy have increased maternal risks compared with the general population. Preeclampsia, gestational hypertension, bleeding in pregnancy, induction of labor, cesarean delivery and major congenital malformations of the children occur more frequently in this group. It has been unclear whether the increased risk of complications is due to the epilepsy per se, the use of antiepileptic drugs, or the combination of both factors. Recent studies have focused on the potential effects of antiepileptic drugs on adverse outcomes in pregnancy. Valproate is the medication most severely affecting the outcome. Folic acid supplementation is recommended to avoid fetal adverse outcome. In this article, principles of guidance in pregnancy and delivery are discussed, with emphasis on the obstetrical provider.