Pregnancy in epilepsy: issues of concern.

Every pregnancy, even under the best of circumstances, carries risks with it. Having epilepsy and taking medications to treat seizures further increase these risks and not all patients are willing to accept risks. The issues related to pregnancy, epilepsy, and antiepileptic drugs and pregnancy are fraught with confusion and misperceptions. Lay publications may misinform the public by assigning risks to drugs not known to be teratogenic in humans. Women report that their physicians have encouraged them to terminate otherwise wanted pregnancies "just to be on the safe side" which is clearly an excess of caution. In this chapter, we review the most common risk factors and divide them in two broad categories: (a) avoidable or modifiable risk factors and (b) unavoidable or non modifiable risk factors. Physicians counseling women with epilepsy who are pregnant or are planning a pregnancy should make every effort to understand the nature and magnitude of the risks associated with epilepsy and antiepileptic drugs in order to ensure the best possible outcomes in these cases. We discuss preventive measures that, when properly followed, can minimize risks and allow the vast majority of women with epilepsy to give birth to normal children.