All are true in pregnancy with epilepsy except:
Ans. is a, i.e. Seizure risk is decreased by 30%In pregnancy the seizure risk increases and does not decrease, hence our answer is but obvious.Now here I want to tell you about antiepileptic drugs and malformations associated with them.Anti epileptic drugs and malformations:In Women with epilepsy not exposed to Anti epileptic drugs (AEDs), the incidence of major congenital malformations is similar to the background risk for the general population. A prospective Finnish population-based study reported a 2.8% (26/939) rate of congenital malformations in the offspring of Women with epilepsy who were not taking AEDs in the first trimester.In Women with epilepsy who are taking AEDs, the risk of major congenital malformation to the fetus is dependent on the type, number and dose of AED. Among AEDs, lamotrigine, and carbamazepine monotherapy at lower doses have the least risk of major congenital malformation in the offspring.The most common major congenital malformations associated with AEDs are neural tube defects, congenital heart disorders, urinary tract and skeletal abnormalities and cleft palate. Risk of major malformations is 3-5%.A milder form of malformations may be present in 8-15% cases.Sodium valproate is associated with neural tube defects, facial cleft and hypospadias; phenobarbital and phenytoin with cardiac malformations; and phenytoin and carbamazepine with cleft palate in the fetus.A systematic review and meta-analysis of 59 studies provided estimates of incidence of congenital malformation in fetuses born to women taking various AEDs.The risk was highest for women taking sodium valproate (10.7 per 100, 95% Cl 8.16-13.29) or AED polytherapy (16.8 per 100, 95% Cl 0.51-33.05) compared with the 2.3 per 100 (95% Cl 1.46-3.1) observed in mothers without epilepsy.Data from the EURAP study group 13 suggest that the lowest rates of malformation were observed in women exposed to less than 300 mg per day of lamotrigine (2 per 100, 95% Cl 1.19-3.24) and to less than 400 mg per day of carbamazepine (3.4 per 100, 95% Cl 1.11-7.71).
Seizure risk is decreased by 30%
Valproate causes adverse fetal outcomes
AED causes malformations in 15% cases
Monotherapy is better
Medical & Surgical Illness Complication Pregnancy