Seizure Disorders in Pregnancy

Posted by e-Medical PPT
Approximately 1 million women of childbearing age in the United States have seizure disorders. Women with epilepsy appear to have a greater baseline risk of fetal malformations, which is further increased with the use of antiepileptic drugs (AEDs). During pregnancy, the volume of distribution and hepatic metabolism of AEDs are increased. This, along with decreased compliance with AEDs because of concerns about effects on the fetus, leads to an increase in seizure frequency.Generalized tonic-clonic seizures during pregnancy can lead to increased maternal trauma. If the maternal trauma involves the abdomen, a theoretical risk of abruption exists, possibly leading to fetal hypoxia or death. Furthermore, the risk of maternal aspiration can lead to maternal hypoxia, which can also lead to fetal hypoxia.
Specific increases in congenital abnormalities observed in infants born to mothers with epilepsy include a 4-fold increase in cleft lip and palate and a 3- to 4-fold increase in cardiac anomalies. An increase in the rate of neural tube defects is also observed in the offspring of patients with epilepsy who are using carbamazepine or valproic acid. Long-term studies on neurodevelopment show higher rates of abnormal EEG findings, higher rates of developmentally delayed children, and lower intelligence quotient (IQ) scores.Fetal hydantoin syndrome consists of an array of anomalies, including craniofacial anomalies, distal digital hypoplasia, epicanthal folds, hypertelorism, low-set ears, and developmental delay.

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