A 35-year-old female with epilepsy, controlled with phenytoin, is planning to become pregnant. What advice should you give her?
Phenytoin is known to increase the risk of birth defects and can interfere with the effectiveness of folic acid, increasing the risk of neural tube defects. It would be prudent to discuss switching to a safer antiepileptic medication prior to conception, such as lamotrigine or levetiracetam. Additionally, all women planning to conceive should take folic acid supplementation to decrease the risk of neural tube defects.