To manage epilepsy in pregnancy is to balance the maternal and fetal risks associated
with uncontrolled seizures against the risks of adverse effects on the fetus caused
by exposure to potentially teratogenic antiepileptic drugs (AEDs). Uncontrolled major
convulsive seizures can have devastating consequences for the mother as well as negative
effects on the fetus. At the same time, AEDs could affect intrauterine growth, increase
the risk of major congenital malformations (MCM) and of impaired cognitive and behavioral
development of the offspring. Research in recent years have demonstrated differences
in teratogenic potential between AEDs and also shown that such effects are dose-dependent.
In particular, valproic acid has been shown to be associated with greater teratogenic
risks than other AEDs, and should whenever possible be avoided in women of childbearing
potential. Among newer AEDs, there are also signals indicating increased risks with
topiramate.
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