Anticonvulsant Management in Pregnancy

Medication Selection

• Oxcarbazepina presents a favorable teratogenic profile, although with less evidence than lamotrigina and levetiracetam, and serum level monitoring is recommended during pregnancy 1
• The American Academy of Family Physicians recommends that women with epilepsy have approximately one-third chance of experiencing more seizures during pregnancy 4

Lactation

• The American Academy of Family Physicians suggests that breastfeeding should be encouraged in women with epilepsy taking anticonvulsants like lamotrigina or levetiracetam, with monitoring of the baby for possible adverse effects 1

Preconception and Prenatal Care

• The American Academy of Family Physicians recommends supplementation with folic acid (4 mg daily) starting at least one month before conception and continuing during the first trimester to reduce the risk of major congenital malformations, especially neural tube defects 3, 4

Special Considerations

• The American Academy of Family Physicians notes that women with epilepsy have an increased risk of congenital anomalies, regardless of whether they are taking medication, and that achieving seizure control before pregnancy is essential to reduce maternal and fetal morbidity 4
• Carbamazepina requires caution due to its teratogenic potential and the need for HLA-B*15:02 testing before initiating treatment, especially in the Asian population 2