Epilepsy and unintended pregnancies.

Abstract

Women with epilepsy (WWE) have increased risk of adverse pregnancy outcomes for both the mother and child.1,2 Some of these risks can be reduced by planning prior to pregnancy. Risks of major congenital malformations and adverse cognitive/behavioral outcomes are higher for certain antiepileptic drugs (AEDs). For example, guidelines recommend avoiding the use of valproate during pregnancy.1 However, waiting until a woman knows she is pregnant and contacts her physician creates a risk of fetal exposure during early pregnancy. Further, changing AED during pregnancy risks precipitating seizures. Waiting until a woman is planning pregnancy does not work as many pregnancies are unplanned. Even in the general population, unintended pregnancies may increase the risk of unfavorable outcomes and of abortions (42% in 2011 excluding miscarriages).3,4 Thus, understanding the rates of unintended pregnancy in WWE is important. No prior large-scale studies have examined the rate and predictors of unintended pregnancies in WWE, despite the fact that some AEDs with enzyme-inducing properties can lower hormonal contraceptive levels.