A 36-year-old G0 who has been epileptic for many years is contemplating pregnancy and wants to go off her anticonvulsant medications because she is concerned regarding the adverse effects that these medications may have on her unborn fetus. All of the following statements are true regarding epilepsy and pregnancy except
(Cunningham, 21/e, pp 205, 213, 1009, 1012-1014.) Offspring of women with epilepsy have 2 to 3 times the risk of congenital anomalies even in the absence of anticonvulsant medications because seizures cause a transient reduction in uterine blood flow and fetal oxygenation. When anticonvulsant medications are used, pregnant women have an even greater risk of congenital malformations. It is recommended that women undergo a trial of being weaned off their medications prior to becoming pregnant. If antiseizure medications must be used, monotherapy is preferred to minimize the risk to the fetus since the incidence of fetal anomalies increases as additional anticonvulsants are consumed. Many anticonvulsants have been found to impair folate metabolism, and folate supplementation in pregnancy has been associated with a decreased incidence of congenital anomalies in epileptic women taking antiseizure medications. Fetal exposure to valproic acid has been associated with a 1 to 2% risk of spina bifida.
Babies born to epileptic mothers have an increased risk of structural anomalies even in the absence of anticonvulsant medications
Epileptic women should have their neurologist attempt to wean them off their anticonvulsant medications prior to conceiving
Phenytoin (Dilantin) is associated with a 1 to 2% risk of spina bifida
Folic acid supplementation reduces the risk of congenital anomalies in fetuses of epileptic women taking anticonvulsants