Care and management of women with epilepsy in pregnancy

The care and management of women with epilepsy in pregnancy and postpartum is complex and there is a great need to coordinate obstetric, epilepsy and primary care to maximise the safety of women and their unborn babies. There are high percentages of unplanned pregnancies, failure of birth control – especially to women on enzyme-inducing anti-seizure medication – and women not taking folate preconception. Healthcare professionals and women with epilepsy face many challenges with having to balance maternal and fetal risks owing to seizures versus the teratogenic risks associated with exposure to anti-seizure medication. Sudden unexpected death in epilepsy remains the highest cause of maternal and fetal mortality and morbidity. The aim of this article is to assess how epilepsy and anti-seizure medication affect maternal and fetal outcomes in pregnancy, review evidence-based approaches for managing epilepsy safely during pregnancy, and identify practical clinical considerations for labour, delivery and postpartum for women with epilepsy.