Risks to the Infant

It is generally thought that women with epilepsy carry at least a 90 percent chance of having a normal, healthy baby.

It is estimated that women with epilepsy carry a 4–6 percent the risk for having a baby born with a malformation. A number of factors are thought to increase congenital malformations in the children of women with epilepsy, which include:

  • genetic predisposition
  • seizures that occur during pregnancy, and
  • the effects of AEDs.

Abnormal fetal development may be caused by an AED-based folate disturbance. Folate (folic acid) is an important component in many chemical reactions in the body. It is necessary for producing the amino acids that form proteins in the body. Many AEDs can decrease the level of folate in the blood, which might lead to metabolic dysfunction, abnormal fetal development, and malformations.

Major malformations that may occur include the following:

  • neural tube defects (e.g., spina bifida)
  • cleft palate
  • cleft lip
  • heart defects

The risk of giving birth to a child with major malformations increases with the number of medications taken simultaneously. Combination therapy of Tridione and Paradione, as well as the other AEDs mentioned here, may cause more extensive birth defects.

Some of these drugs are being prescribed less often by physicians because of their association with such defects. Also, AED use is restricted for patients who have a family history of neural tube defects. Again, pregnant women should consult with their physician regarding their medication.

AED-associated minor abnormalities that carry no long-term medical consequences include:

  • developmental delay
  • speech abnormalities
  • widened eye set
  • flattened nasal bridge
  • small fingernails

Epilepsy & Pregnancy Precautions

A woman with epilepsy can take many precautions to reduce the risk for malformations developing in a fetus:

  • have a full neurological evaluation prior to conception
  • involve an epileptologist or a neurologist in prenatal care and during pregnancy
  • switch to lowest possible dose monotherapy (one AED) before becoming pregnant
  • take daily multivitamin supplements with folate (folic acid)
  • undergo a thorough ultrasound examination at 16–18 weeks of gestation
  • have amniocentesis and alpha-fetoprotein tests

Seizures can potentially affect a developing fetus by decreasing oxygen or blood supply to the womb, so the decision to reduce dosage should only be made at the discretion of a physician who understands the biological and physiological patterns of epilepsy.

Taking folate can help minimize the risk of congenital spinal cord malformations. A minimal dose of 2 mg a day to maintain proper folate balance before and during pregnancy is recommended.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published:

Last Modified: 15 Dec 2014