Current Management of Epilepsy and Pregnancy: Fetal Outcome, Congenital Malformations, and Developmental Delay

Purpose. Women with epilepsy (WWE) reportedly have increased rates of pregnancy complications and poor fetal outcomes related to both their epilepsy and antiepileptic drugs (AEDs). These results influence decisions about conceiving. Most published studies evaluate WWE treated before 1990. We sought to better define risks to pregnant WWE at a tertiary care center, which used current epilepsy guidelines. Methods. We retrospectively analyzed 100 consecutive pregnancies in WWE from 1990 to 2000. Maternal data: epilepsy syndrome, duration, AEDs used, seizure occurrence and frequency, delivery type and complications. Fetal outcomes: fetal birth weight (FBW), gestational age, incidence of prematurity, major and minor congenital malformations, developmental delay. Results. Maternal factors: 37% generalized and 63% partial epilepsies, 59% seizure-free throughout pregnancy, 30% increased and 22% decreased seizure frequency, 90% used AEDs, 21% required polytherapy, 98% took folate, and 48% with gestational seizures delivered by cesarean section, compared with 18% without seizures (P < 0.01). Fetal outcome: Mean FBW and gestational ages similar regardless of AED usage or exposure to maternal seizures, 3.9% prematurity, no cases of still birth or neonatal hemorrhagic disorder, 1.1% of children exposed to AEDs had major congenital malformations, and 6.2% of offspring had pervasive developmental delay (PDD). Conclusions. All fetal outcomes were similar to outcomes for the general population, with the exception of higher rates of PDD and cesarean section. In our small sample of WWE treated with current epilepsy management, the majority had excellent outcomes. Future large studies must confirm this. (C) 2001 Academic Press