medications.
The effect of anticonvulsants on the fetus and infant is that congenital
malformation rate increase from 3% to >10%. In addition, cerebral palsy, seizure
disorders, and intellectual disability are increased in offspring of epileptic
women. Maternal phenytoin use is associated with neonatal deficiency of
vitamin K-dependent clotting factors: II, VII, IX, and X.
Management. Ensure extra folic acid supplementation before conception and
during embryogenesis to minimize neural tube defects.
Anomaly screening. Offer triple-marker screen and second trimester
sonography to identify neural tube defects (NTDs) or other anomalies.
Drug monotherapy. Use a single drug if possible, at the lowest possible
dose, to ensure freedom from seizures.
Medication levels. Monitor anticonvulsant levels each trimester and adjust
dose as needed. Prevent seizures to minimize maternal and fetal hypoxia.