1-Seizure frequency may increase: due to:
-Enhanced metabolism & increased drug clearance associated with
pregnancy can result in decreased serum drug concentration.
-Increased volume of distribution of the AED.
-Increased serum binding proteins.
-Decreased or non-compliance with medication.
-Sleep deprivation, hormonal changes of pregnancy (high E), and
associated psychological and emotional stress of pregnancy: all lower
threshold for seizures.
Effect Of Epilepsy On Pregnancy
Data on 1st trimester losses, PROM, ante-partum hemorrhage, operative vaginal delivery and CS are inconclusive.
Increased incidence of IUGR, cognitive dysfunction, microcephaly and perinatal mortality (1.2 - 3 times normal).
Increased incidence of congenital malformations.
Effects Of Epilepsy On Fetus And Neonate
1-There is increased risk for infants of epileptic mothers to have epilepsy. The risk of neonatal susceptibility depends on:
Nature of the mother’s seizure disorder.
Seizures arises during pregnancy.
Metabolic & toxic consequences of seizures and AEDs.
2-Increase perinatal morbidity.
Specific Syndromes Of Malformations
Fetal Hydantoin Syndrome:
11% of infants exposed will have the syndrome.
There is pre and postnatal growth deficiency, dysmorphic facies and mental retardation.
Facial Valproate Syndrome:
Brachycephaly with high forehead, shallow orbits, small nose, small mouth & low posterior ears.
Long overlapping fingers & toes & hyperconvex nails.
Cleft palate & congenital heart diseases..