Fetal heart rate decelerations have been recorded during seizures. Many women first present to their MD after 2-3 months of pregnancy. Note that neural tube closes by 28 days, heart is formed by 6 weeks, face forms up to 10 weeks. Management at this point in epileptic women consists of optimal seizure management and fetal diagnostic procedures to evaluate birth defects. Therefore, prenatal discussion is needed to maximize fetal outcome by medication adjustment and folate treatment.
Phenobarbital levels decrease early in pregnancy.
In general, minor AED dosage adjustments are required if clinical status changes, and should be correlated with free drug levels if possible. Monitor levels approximately every 4-6 weeks. Congenital abnormalities are increased 2-3x over the normal population. This is thought to be due to the use of monotherapy, folate supplement and the use of carbamazepine monotherapy. Teratogenicity in patients' offspring has been reported with all AEDs.