Epilepsy and pregnancy: good management reduces the risks.

It is vital to review medication before pregnancy to minimise the risk of a malformed fetus. The risk of fetal malformation can be at least double for women on the commoner anticonvulsants, especially if these are taken in combination. Two newer anticonvulsants (gabapentin and lamotrigine) appear to be less harmful to the fetus. One-third of women with epilepsy have an increase in seizures during pregnancy. The fetus appears to be relatively resistant to the mother's seizures, though (rarely) intrauterine deaths have occurred. As well as fetal malformation, children born to women with epilepsy are at greater than normal risk of still birth, neonatal and prenatal death, haemorrhagic disease of the newborn, low Apgar score and low birth weight. With careful management the majority of women with epilepsy will have a better than 90% chance of a normal baby, but getting a medication right before pregnancy is essential.