Pregnancies in women with epilepsy

The  aim  of  this  study  was  to  analyse  the  outcomes  of  all  the pregnancies  of  each  woman  with  epilepsy  in  the  Australia  Pregnancy  Register. Data from 1,290 pregnancies in 612 women with epilepsy were analysed, including 156 women who took no AEDs in the first trimester of at least one pregnancy. Spontaneous  miscarriages  were  more  frequent  in  AED-exposed  pregnancies. There was an overall 13·95% risk of a woman taking AEDs during pregnancy having a malformed foetus at some stage of her reproductive career, at least to the time of the present analysis. This risk increased with (i) first trimester exposure to VPA, particularly in maternal doses above 1,100–1,400 mg per day, (ii) the number of pregnancies  a  woman  underwent, although  the  individual  pregnancy  risk  did  not increase from one pregnancy to the next, (iii) history of a previous foetus with a malformation  from  an  AED-associated  pregnancy, (iv)  twin  pregnancies, and  (v) family histories of foetal malformations. These findings provide a basis for advising women with epilepsy about the likely overall outcomes of their child-bearing careers, and  suggest  that  both  genetic  and  drug-related  factors  operate  in  producing  foetal malformations. The issue is one of frequent concern and discussion with participants in the Pregnancy Register.