Management of Antiepileptic Drugs in Early Pregnancy

Timing of Antiepileptic Drug Exposure

• All antiepileptic drugs should be avoided during the first trimester because the risk of major congenital malformations is highest during this period (Circulation guideline, 2016) [1][2].

Preconception Folic Acid Supplementation

• Women planning pregnancy should take folic acid 4–5 mg daily, beginning at least one month before conception and continuing through the first trimester to reduce neural‑tube defect risk (American Family Physician, 2013) 3.

Risk‑Benefit Assessment After First Trimester

• For pregnancies beyond six weeks gestation, clinicians must balance the potential teratogenic risk of switching antiepileptic medication against the risk of seizure recurrence, and make individualized decisions regarding continuation or substitution of clobazam (American Journal of Obstetrics & Gynecology, 2024) 4.

Maternal and Fetal Monitoring

• When antiepileptic therapy is continued after the first trimester, a comprehensive monitoring plan should include: